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NCLEX-RN® > NCLEX-RN (4) Pharmacology > Cardiac Meds > Flashcards

Cardiac Meds Flashcards

Review all the important cardiac meds: classifications, indications, side effects, adverse reactions, and nursing considerations.

1
Q

Indication:

Angiotensin-converting enzyme inhibitors

(ACE inhibitors)

A
  • Antihypertensive
  • to decrease blood pressure
  • to prevent myocardial infarction and cerebral vascular accident
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2
Q

Generic names:

ACE inhibitors

A

benazepril, enalapril, lisinopril, ramipril

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3
Q

Mechanism of action:

ACE inhibitors

A
  • prevents conversion of angiotensin I to angiotensin II, a potent vasoconstrictor
  • blood vessels enlarge and blood pressure decreases
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4
Q

Most common side effects:

ACE inhibitors

A
  • hypotension and dizziness
  • hyperkalemia
  • dry cough
  • taste changes
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5
Q

Nursing considerations:

ACE inhibitors: hypotension and dizziness

A
  • take blood pressure and hold if BP < 100/60
  • use caution when getting up due to orthostatic hypotension
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6
Q

Nursing considerations:

ACE inhibitors: hyperkalemia

A
  1. check potassium and hold if increased - normal potassium is 3.5 - 5
  2. use caution with kidney failure clients - clients retain potassium
  3. avoid salt substitutes - contains potassium
  4. use caution with potassium-sparing diuretics - spironolactone: retains potassium
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7
Q

Nursing considerations:

ACE inhibitors: dry cough

A

May need to prescribe different med if cough is intolerable to client.

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8
Q

Nursing considerations:

ACE inhibitors: taste changes

A

Advise client that the changes to diet may need to occur such as eating smaller meals, or drinking lemon juice between meals.

These changes can make eating foods more tolerable.

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9
Q

Most common adverse reaction:

ACE inhibitors

(Immediate complication)

A

angioedema (swelling of face and neck)

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10
Q

Nursing considerations:

ACE inhibitors: angioedema

(Immediate complication)

A
  • assess airway
  • assess for swelling and difficulty breathing

Hold med and notify HCP.

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11
Q

Indication:

Angiotensin receptor blockers

A
  • Antihypertensive
  • to decrease blood pressure
  • to reduce risk of stroke and myocardial infarction
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12
Q

Generic names:

Angiotensin receptor blockers

A

irbesartan, losartan, olmesartan, valsartan

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13
Q

Mechanism of action:

Angiotensin receptor blockers

A
  • blocks angiotensin II, a potent vasoconstrictor
  • blood vessels enlarge and blood pressure decreases
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14
Q

Most common side effects:

Angiotensin receptor blockers

A

hypotension and dizziness

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15
Q

Nursing considerations:

Angiotensin receptor blockers: hypotension and dizziness

A
  • take blood pressure and hold if BP < 100/60
  • use caution when getting up due to orthostatic hypotension
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16
Q

Nursing considerations:

Angiotensin receptor blockers: hyperkalemia

A
  1. check potassium and hold if increased - normal potassium is 3.5 - 5
  2. use caution with kidney failure clients - clients retain potassium
  3. avoid salt substitutes - contains potassium
  4. use caution with potassium-sparing diuretics - spironolactone: retains potassium
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17
Q

Most common adverse reaction:

Angiotensin receptor blockers

(Immediate complication)

A

angioedema (swelling of face and neck)

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18
Q

Nursing considerations:

Angiotensin receptor blockers: angioedema

(Immediate complication)

A
  • assess airway
  • swelling or difficulty breathing

Hold med and notify HCP.

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19
Q

Indication:

Antiarrhythmic: adenosine

(Immediate complication)

A
  • to treat supraventricular tachycardia (SVT)
  • will chemically cardiovert to normal sinus rhythm when given IV push
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20
Q

Indication:

Antiarrhythmic: amiodarone

(Immediate complication)

A

To treat or prevent life-threatening ventricular fibrillation or ventricular tachycardia.

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21
Q

Indication:

Antiarrhythmic: lidocaine

(Immediate complication)

A
  • to treat or prevent life-threatening ventricular fibrillation or ventricular tachycardia
  • given when amiodarone is not available
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22
Q

Indication:

Antiarrhythmic: atropine

(Immediate complication)

A
  • will increase the heart rate when given IV push
  • to treat heart blocks and symptomatic bradycardia
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23
Q

Indication:

Anticoagulants

A

To treat and prevent blood clots for clients with:

  • arrhythmias such as atrial fibrillation
  • valve replacement
  • myocardial infarction
  • deep vein thrombosis
  • pulmonary embolism
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24
Q

Generic names:

Anticoagulants

A
  • apixaban, dabigatran, rivaroxaban
  • enoxaparin
  • heparin
  • warfarin
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25
Q

Most common adverse reaction:

Anticoagulants

(Immediate complication)

A

Bleeding

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26
Q

Nursing considerations:

Anticoagulants

A
  • assess for bleeding
  • hold if platelets <150,000 or active bleeding
  • hold if significant decrease in hemoglobin and hematocrit
  • avoid herbs since many cause bleeding
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27
Q

Indication:

Anticoagulant: enoxaparin

A
  • a low molecular weight heparin given subcutaneously
  • to prevent blood clots, especially post-op clients
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28
Q

Indication:

Anticoagulant: heparin

A
  1. heparin IV
    • to treat an active blood clot
    • bridge therapy for PO anticoagulants
  2. heparin subcutaneous - to prevent blood clots
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29
Q

Nursing considerations:

Anticoagulant: heparin

A
  1. If giving IV: hold if aPTT or PTT is > therapeutic
  2. don’t store with insulin bottles - both are given by units and bottles look the same
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30
Q

Therapeutic aPTT for Intravenous heparin:

A

45 to 100

  • the control value is 30 - 40: (control value can vary)
  • therapeutic is 1.5 to 2.5 times the control value

How to calculate: therapeutic is 1.5(30) to 2.5(40) = 45 to 100. Decrease infusion rate if therapeutic level is >100

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31
Q

Antidote to heparin:

A

protamine sulfate

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32
Q

Indication:

Anticoagulant: warfarin

A

To prevent blood clots for those with arrhythmias or valve replacement.

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33
Q

Nursing considerations:

Anticoagulant: warfarin

A
  1. assess for bleeding - hold if actively bleeding
  2. check PT and INR - hold if PT or INR is > therapeutic level
  3. don’t increase or decrease amount of green leafy vegetables consumed - they contain vitamin K, which is the antidote
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34
Q

Therapeutic INR for warfarin:

A
  • 2-3 for clients with atrial fibrillation
  • 3-4 for clients with a prosthetic valve
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35
Q

Therapeutic PT for warfarin:

A

16.5 to 25

  • the control value is 11 - 12.5: (control value can vary)
  • therapeutic is 1.5 to 2 times the control value

How to calculate: therapeutic is 1.5(11) to 2(12.5) = 16.5 to 25. Hold if the therapeutic level is >25.

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36
Q

Antidote to warfarin:

A

phytonadione (vitamin K)

37
Q

Indication:

Antiplatelets

A

To prevent blood clots.

38
Q

Generic names:

Antiplatelets

A
  • aspirin (or called acetylsalicylic acid)
  • clopidogrel, prasugrel
39
Q

Most common adverse reaction:

Antiplatelets

(Immediate complication)

A

Bleeding

40
Q

Nursing considerations:

Antiplatelets

A

​Assess for bleeding

  • hold if platelets <150,000 or active bleeding
  • hold if significant decrease in hemoglobin and hematocrit
  • avoid herbs since many cause bleeding
41
Q

Indication:

Antiplatelet: aspirin

A

Can also be given as an analgesic to prevent pain and inflammation.

42
Q

Most common side effects and nursing considerations:

Antiplatelet: aspirin

A
  1. assess for ringing in ears - ototoxic
  2. don’t give to children < 18 years old - can cause Reye’s syndrome
43
Q

Indication:

Beta blockers

A
  • Antihypertensive
  • to decrease blood pressure and heart rate
  • to prevent myocardial infarction
44
Q

Generic names:

Beta blockers

A

atenolol, carvedilol, metoprolol, nebivolol, propranolol

45
Q

Mechanism of action:

Beta blockers

A
  • blocks beta receptors
  • decreases cardiac output and cardiac oxygen consumption
  • heart beats more slowly and with less force
46
Q

Most common side effects:

Beta blockers

A
  • bradycardia and hypotension
  • erectile dysfunction
47
Q

Nursing considerations:

Beta blockers: bradycardia and hypotension

A

Check heart rate and blood pressure.

hold if HR <60 or BP <100/60

48
Q

Nursing considerations:

Beta blockers: erectile dysfunction

A

Teach client that taking medications that lower blood pressure and erectile dysfunction drugs together can cause severe hypotension.

49
Q

Nursing considerations:

Beta blockers: asthma/COPD and diabetics

A
  1. use caution with asthma or COPD - can cause bronchoconstriction
  2. use caution with diabetics - can mask signs of hypoglycemia
50
Q

Indication:

Calcium channel blockers

A
  • Antihypertensive
  • to decrease blood pressure and heart rate
  • to treat angina
51
Q

Generic names:

Calcium channel blockers

A
  • amlodipine, nifedipine
  • diltiazem​ and verapamil
52
Q

Mechanism of action:

Calcium channel blockers

A
  • prevents movement of calcium in cardiac cells
  • this dilates the arteries of the heart, which decreases blood pressure and myocardial oxygen demand
53
Q

Most common side effects:

Calcium channel blockers

A
  • hypotension and dizziness
  • bradycardia
  • edema
54
Q

Nursing considerations:

Calcium channel blockers: hypotension and dizziness

A
  1. check BP - hold if BP <100/60
  2. falls precautions
55
Q

Nursing considerations:

Calcium channel blockers: bradycardia

A

Check heart rate and hold if < 60.

56
Q

Nursing considerations:

Calcium channel blockers: edema

A

Assess for peripheral and pulmonary edema.

hold med and notify HCP

57
Q

Nursing considerations:

Calcium channel blockers: food-med interaction

A

Drinking grapefruit juice and taking medication together will decrease blood pressure.

58
Q

Indication:

digoxin

A

To decrease heart rate with heart failure or atrial fibrillation.

59
Q

Most common adverse reactions:

digoxin

A
  • bradycardia
  • nausea/vomiting
  • vision changes
60
Q

Nursing considerations:

digoxin: bradycardia

A

Check heart rate - hold if:

  • <60 for adult
  • <70 for child
  • <90 in an infant
61
Q

Nursing considerations:

digoxin: toxicity

A
  • monitor for symptoms of toxicity: nausea/vomiting, vision changes, and bradycardia
  • check potassium level: can get toxicity if potassium is low
62
Q

therapeutic level of digoxin:

A

1 - 2

2 or greater is considered toxicity.

63
Q

Antidote to digoxin:

A

digoxin immune fab

64
Q

Indication:

Nitrates

A
  • Antianginal
  • Vasodilator
  • to treat chest pain and decrease blood pressure
65
Q

Generic names:

Nitrates

A
  • isosorbide dinitrate, isosorbide mononitrate
  • nitroglycerin
66
Q

Mechanism of action:

Nitrates

A

Relaxes vascular smooth muscle causing vasodilation and decreased blood pressure.

67
Q

Most common side effects:

Nitrates

A
  • headache
  • hypotension
68
Q

Nursing considerations:

Nitrates: headache and hypotension

A
  • headache - lower the head of the bed to decrease pain
  • hypotension
    • don’t give if BP <100/60
    • don’t give if taking erectile dysfunction drugs - can cause severe hypotension
69
Q

Nursing considerations:

nitroglycerin sublingual

A
  • give 1 sublingual tablet every 5 minutes for chest pain
  • give up to 3 doses
  • call ambulance or notify HCP if not relieved by 2 doses
70
Q

Indication:

Thrombolytics

A
  • “clot busters”
  • to break up blood clots
71
Q

Generic names:

Thrombolytics

A

alteplase, streptokinase, tenecteplase

72
Q

Most common side effects and nursing considerations:

Thrombolytics

A

Assess for active bleeding or recent stroke.

hold med if actively bleeding

73
Q

Indication:

Vasopressor: dopamine

(Immediate complication)

A

To treat shock.

74
Q

Nursing considerations:

Vasopressor: dopamine

A
  1. assess blood pressure and heart rate while giving - give fluids before giving med to increase blood pressure
  2. may cause arrhythmias - keep client on continuous ECG monitoring
75
Q

Indication:

Vasopressor: epinephrine

(Immediate complication)

A

To treat anaphylaxis, shock, severe asthma attack, treat life-threatening arrhythmias.

asystole, ventricular tachycardia, ventricular fibrillation

76
Q

Nursing considerations:

Vasopressor: epinephrine IM shot

A

Teach client to self-administer in outer thigh as an IM shot for those at risk of anaphylaxis.

77
Q

Nursing considerations:

Diuretics

A
  1. Assess kidney function due to diuresis - BUN, creatinine, urine output
  2. Assess lung sounds - fluid can back up into lungs and there should be decreased crackles and clear lung sounds after giving
  3. Assess for edema - edema should decrease after giving
78
Q

Indication:

Loop diuretics

A

To treat edema and hypertension.

79
Q

Generic names:

Loop diuretics

A
  • also called “potassium-wasting diuretics” because potassium and urine is excreted
  • furosemide, bumetanide, torsemide
80
Q

Indication:

Thiazide diuretics

A

To treat edema and hypertension.

81
Q

Generic names:

Thiazide diuretics

A
  • also called “potassium-wasting diuretics” because potassium and urine is excreted
  • hydrochlorothiazide, chlorthalidone
82
Q

Most common side effects:

Loop diuretics and Thiazide diuretics

A

hypokalemia

83
Q

Nursing considerations:

Loop diuretics and Thiazide diuretics: hypokalemia

A
  1. Check potassium level - can cause decreases in potassium
  2. Assess for muscle cramps or dysrhythmias - can be caused by low potassium
  3. Give potassium supplements if potassium is low
    • can be given PO (by mouth) if not severe
    • given IVPB if severe hypokalemia
84
Q

Indication:

Potassium-sparing diuretic

A

To treat hypertension and edema by diuresis.

85
Q

Generic names:

Potassium-sparing diuretic

A

Spironolactone

86
Q

What are signs/symptoms of bleeding?

A
  • bright red blood from anywhere
  • hematuria
  • melena/tarry stools
  • bruising
  • bleeding gums
  • large drops in hemoglobin and hematocrit
  • low platelet count of <50,000
  • epistaxis
  • hematemesis
  • petechiae/purpura

These symptoms could indicate the the client has taken too much anticoagulant or antiplatelet medication.

87
Q

What are interventions for bleeding precautions?

A
  • no straining (give stool softeners)
  • no nail clippers or straight-edge razors
  • no meds that increase the risk of bleeding
  • apply pressure for at least 5 minutes to any bleeding site
  • limit invasive procedures
  • prevent falls
  • assess for signs of bleeding
  • avoid herbs that start with the letter “G”
  • floss and brush teeth gently
88
Q

Which medications increase the risk of bleeding?

A
  • Antiplatelets
  • Anticoagulants
  • NSAIDs
  • Thrombolytics
  • Chemotherapy
  • Herbs that start with the letter “G” (garlic, ginger)

NCLEX-RN (4) Pharmacology (12 decks)

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