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

Flashcards in Cardiac Meds Deck (84)
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1
Indication:

Angiotensin-converting enzyme inhibitors

(ACE inhibitors)

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

2
Generic names:

ACE inhibitors

benazepril, enalapril, lisinopril, ramipril

3
Mechanism of action:

ACE inhibitors

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

4
Most common side effects:

ACE inhibitors

  • hypotension and dizziness
  • hyperkalemia
  • dry cough

5
Nursing considerations:

ACE inhibitors: hypotension and dizziness

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

6
Nursing considerations:

ACE inhibitors: hyperkalemia

  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

7
Nursing considerations:

ACE inhibitors: dry cough

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

8
Most common adverse reaction:

ACE inhibitors

Immediate complication

 

angioedema (swelling of face and neck)

9
Nursing considerations:

ACE inhibitors: angioedema

Immediate complication

  • assess airway
  • assess for swelling and difficulty breathing

Hold med and notify HCP.

10
Indication:

Angiotensin receptor blockers

 

  • Antihypertensive
  • to decrease blood pressure and heart rate
  • to reduce risk of stroke and myocardial infarction

11
Generic names:

Angiotensin receptor blockers

irbesartan, losartan, olmesartan, valsartan

12
Mechanism of action:

Angiotensin receptor blockers

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

 

13
Most common side effects:

Angiotensin receptor blockers​

hypotension and dizziness

14
Nursing considerations:

Angiotensin receptor blockers: hypotension and dizziness

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

15
Most common adverse reaction:

Angiotensin receptor blockers​

Immediate complication

angioedema (swelling of face and neck)

16
Nursing considerations:

Angiotensin receptor blockers: angioedema

Immediate complication

  • assess airway
  • swelling or difficulty breathing

Hold med and notify HCP.

17
Indication:

Antiarrhythmic: adenosine

Immediate complication

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

18
Indication:

Antiarrhythmic: amiodarone

Immediate complication

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

19
Indication:

Antiarrhythmic: lidocaine

Immediate complication

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

20
Indication:

Antiarrhythmic: atropine

Immediate complication

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

 

21
Indication:

Anticoagulants

To treat and prevent blood clots for clients with:

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

 

22
Generic names:

Anticoagulants

  • apixaban, dabigatran, rivaroxaban
  • enoxaparin
  • heparin
  • warfarin

 

23
Most common adverse reaction:

Anticoagulants

Immediate complication

Bleeding

24
Nursing considerations:

Anticoagulants

  • 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

 

25
Indication:

Anticoagulant: enoxaparin

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

26
Indication:

Anticoagulant: heparin

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

27
Nursing considerations:

Anticoagulant: heparin

  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

28

Therapeutic aPTT for Intravenous heparin:

Therapeutic aPTT for Intravenous heparin: 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

29

Antidote to heparin:

protamine sulfate

30
Indication:

Anticoagulant: warfarin

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

31
Nursing considerations:

Anticoagulant: warfarin

  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

32

Therapeutic INR for warfarin:

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

33

Therapeutic PT for warfarin:

Therapeutic PT for warfarin: 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.

34

Antidote to warfarin:

phytonadione (vitamin K)

35
Indication:

Antiplatelets

To prevent blood clots

36
Generic names:

Antiplatelets

  • aspirin (or called acetylsalicylic acid)
  • clopidogrel, prasugrel

37
Most common adverse reaction:

Antiplatelets

Immediate complication

Bleeding

38
Nursing considerations:

Antiplatelets

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

39
Indication:

Antiplatelet: aspirin

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

40
Most common side effects and nursing considerations:

Antiplatelet: aspirin

  1. assess for ringing in ears
    • ototoxic
  2. don't give to children < 18 years old
    • can cause Reye's syndrome

41
Indication:

Beta blockers

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

42
Generic names:

Beta blockers

atenolol, carvedilol, metoprolol, nebivolol

43
Mechanism of action:

Beta blockers

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

44
Most common side effects:

Beta blockers

  • weakness and fatigue
  • bradycardia and hypotension
  • erectile dysfunction

45
Nursing considerations:

Beta blockers: weakness and fatigue

Caution clients to avoid driving or other tasks requiring mental alertness when starting medication.

46
Nursing considerations:

Beta blockers: bradycardia and hypotension

​Check heart rate and blood pressure

hold if HR <60 or BP <100/60

47
Nursing considerations:

Beta blockers: erectile dysfunction

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

48
Nursing considerations:

Beta blockers: asthma/COPD and diabetics

  1. use caution with asthma or COPD
    • can cause bronchoconstriction​
  2. use caution with diabetics
    • can mask signs of hypoglycemia

49
Indication:

Calcium channel blockers

  • Antihypertensive
  • to decrease blood pressure and heart rate
  • to treat angina

50
Generic names:

Calcium channel blockers

  • amlodipine, nifedipine
  • diltiazem​ and verapamil

51
Mechanism of action:

Calcium channel blockers

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

52
Most common side effects:

Calcium channel blockers

  • hypotension and dizziness
  • bradycardia
  • edema

53
Nursing considerations:

Calcium channel blockers: hypotension and dizziness

  1. check BP
    • ​hold if BP <100/60
  2. falls precautions

54
Nursing considerations:

Calcium channel blockers: bradycardia

Check heart rate and hold if < 60

55
Nursing considerations:

Calcium channel blockers: edema

Assess for peripheral and pulmonary edema

hold med and notify HCP

56
Nursing considerations:

Calcium channel blockers: food-med interaction?

Will decrease blood pressure

57
Indication:

digoxin

To decrease heart rate with heart failure or atrial fibrillation.

58
Most common adverse reactions:

digoxin

  • bradycardia
  • nausea/vomiting
  • vision changes

59
Nursing considerations:

digoxin: bradycardia

​Check heart rate

  • hold if <60 for adult, <70 for child, <90 in an infant

60
Nursing considerations:

digoxin: toxicity

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

61

therapeutic level of digoxin:

therapeutic level of digoxin: 1 - 2

2 or greater is considered toxicity.

62

Antidote to digoxin:

digoxin immune fab

63
Indication:

Nitrates

  • Antianginal
  • Vasodilator
  • to treat chest pain and decrease blood pressure

64
Generic names:

Nitrates

  • isosorbide dinitrate, isosorbide mononitrate​
  • nitroglycerin

65
Mechanism of action:

Nitrates

Relaxes vascular smooth muscle causing vasodilation and decreased blood pressure.

66
Most common side effects:

Nitrates

  • headache
  • hypotension

67
Nursing considerations:

Nitrates: headache and hypotension

  • 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

68
Nursing considerations:

nitroglycerin sublingual

  • 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

69
Indication:

Thrombolytics

  • "clot busters"
  • to break up blood clots

70
Generic names:

Thrombolytics

alteplase, streptokinase, tenecteplase

71
Most common side effects and nursing considerations:

Thrombolytics

Assess for active bleeding or recent stroke

hold med if actively bleeding

72
Indication:

Vasopressor: dopamine

Immediate complication

to treat shock

73
Nursing considerations:

Vasopressor: dopamine

  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

74
Indication:

Vasopressor: epinephrine

Immediate complication

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

asystole, ventricular tachycardia, ventricular fibrillation

 

75
Nursing considerations:

Vasopressor: epinephrine IM shot

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

76
Nursing considerations:

Diuretics

 

  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

77
Indication:

Loop diuretics

 

To treat edema and hypertension

78
Generic names:

Loop diuretics

 

  • also called "potassium-wasting diuretics" because potassium and urine is excreted
  • furosemide, bumetanide, torsemide

79
Indication:

Thiazide diuretics

 

To treat edema and hypertension

80
Generic names:

Thiazide diuretics

 

  • also called "potassium-wasting diuretics" because potassium and urine is excreted
  • hydrochlorothiazide, chlorthalidone

81
Most common side effects:

Loop diuretics and Thiazide diuretics

 

hypokalemia

82
Nursing considerations:

Loop diuretics and Thiazide diuretics: hypokalemia

 

  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

83
Indication:

Potassium-sparing diuretic

To treat hypertension and edema by diuresis

84
Generic names:

Potassium-sparing diuretic

Spironolactone