Cardiac (Week 5) Flashcards
(117 cards)
1
Q
Fibers that conduct electrical excitation very rapidly to all parts of the ventricles; causes synchronized ventricular contraction
A
His-Purkinje System
2
Q
What are the two kinds of cardiac action potential?
A
Fast Potential
Slow Potential
3
Q
Where do fast potentials occur in the His-Purkinje System?
A
In the atrial and ventricular muscle
4
Q
What are the 5 phases of Fast Potentials?
A
Phase 0 Phase 1 Phase 2 Phase 3 Phase 4
5
Q
Rapid Depolarization due to influx of sodium ions. Sodium Channel blockers slow impulse conduction
A
Phase 0 of Fast Potentials
6
Q
What phase has no relevance to antidysrhythmic drugs?
A
Phase 1
7
Q
Prolong plateau, calcium enters cell; Beta blockers/Calcium Channel blockers reduce myocardial contractility
A
Phase 2
8
Q
Rapid repolarization caused by potassium from the cell; Can be delayed by potassium channel blockers
A
Phase 3
9
Q
Membrane potential may remain stable or membrane may undergo spontaneous depolarization
A
Phase 4
10
Q
Where do the slow potentials occur?
A
In the cells of the SA and AV node
11
Q
What are the phases of slow potentials?
A
Phase 0
Phase 2
Phase 3
Phase 4
12
Q
Phase ___ is caused by slow influx of calcium
A
Phase 0
13
Q
What causes dysrhythmias?
A
Disturbances of impulse formation
Disturbances of impulse conduction
14
Q
What are the factors that can alter automaticity?
A
Hypoxia Electrolyte imbalance Cardiac surgery MI Decreased Coronary blood flow
15
Q
Name three sodium channel blockers
A
Quinidine
Lidocaine
Flecainide
16
Q
What are the indications for Quinidine?
A
Active against Supraventricular and Ventricular rhythms, Atrial flutter, A Fib
17
Q
What is the MOA of quinidine?
A
Slows impulse conduction in the atria, ventricles and His-Purkinje system
18
Q
What are the adverse effects of Quinidine?
A
Diarrhea Cinchonism Cardiotoxicity Arterial embolism Hypotension
19
Q
What are the nursing considerations for Quinidine?
A
Monitor for dysrhythmias
Report signs of embolism
20
Q
What is the regular dosing for Quinidine?
A
200-400 mg
21
Q
What is the regular dose for lidocaine (Xylocaine)?
A
1mg/kg
22
Q
What are indications for Lidocaine (Xylocaine)?
A
Ventricular dysrhythmias
23
Q
What is the MOA of lidocaine (Xylocaine)?
A
Slows conduction in the atria, ventricles, and His-Purkinhe system
24
Q
What are the adverse effects of Lidocaine (Xylocaine)?
A
HIGH DOSES: drowsiness, confusion, and paresthesias
TOXIC DOSES: Seizure and Resp. Arrest
25
What are some nursing diagnoses for lidocaine (Xylocaine)?
Monitor blood pressure for signs of toxicity
26
What are the indications for Flecainide?
Maintenance therapy of AFib and A Flutters
27
What is the MOA of Flecainide?
Decreases cardiac conduction and increases ERP
28
What are some interactions for Flecainide?
Should not be combined with any drug that reduces myocardial contractility
29
What are the adverse effects of Flecainide?
Arrythmias
Dizziness
Chest Pain
Blurred Vision
30
What are some nursing considerations for Flecainide?
Monitor for worsening dysrhythmia or new ones
| Should be reserved when other drugs have failed
31
Name a non-selective beta-adrenergic antagonist (Beta Blockers)
Propranolol (Inderal LA)
32
What are indications of Propranolol (Inderal LA)
Treatment of dysrhythmias
33
What are the adverse effects of propranolol (Inderal LA)?
```
Heart Failure
AV Block
Sinus Arrest
Hypotension
Bronchospasm (asthma patients)
```
34
What kind of patient is contraindicated for propranolol?
Heart Blocks
| HF
35
What are the 5 potassium channel blockers?
```
Amiodarone
Dronedarone
Dofetilide
Ibutilide
Sotalol
```
**Each drug CANNOT be used interchangeably
36
What is the regular dose of Amiodarone (Corderone)?
800 mg-1600 mg for 1-3 weeks
37
What are the indications of Amiodorone (Corderone)?
Recurrent V Fib
38
What is the MOA of amiodarone (Corderone)?
Delays depolarization, reduced contractility
39
How long can the effects of Amiodarone last?
Effects can last from weeks to months after usage stopped
40
What are the Amiodarone adverse effects?
```
Pulmonary toxicity
Cardiotoxicity
Thyroid toxicity
Liver Toxicity
Ophthalmic Effects
Toxic in pregnancy and breastfeeding
Dermatologic toxicity
CNS
GI (NV)
```
41
Amiodarone levels can be increased by what?
Grapefruit juice
42
Severe dysrhythmias can occur with the use of diuretics with that drug?
Amiodarone
43
Initial treatment and prevention of V Fib
| Slows down AV Conduction
IV Amiodarone
44
What kind of drug is Sotalol (Betapace)?
Beta blocker
45
What are the indications of Stall (Betapace)?
Life threatening Ventricular dysrhythmias
A Fib
A flutter
46
What is the MOA of Sotalol (Betapace)?
Delays depolarization
47
What are the adverse effects of Sotalol (Betapace)?
Torsades de pointes
48
Name 2 calcium channel blockers
Verapamil (Calan)
| Cardizem (Diltiazem)
49
What is the regular dosages for Verapamil and Cardizem?
5-10 mg injected over 2-3 mins
| Bolus 0.25 mg/kg
50
What are the indications for Verapamil (Calan) and Cardizem (Diltiazem)?
A Fib
A Flutter
SVT termination
51
What is the MOA of Verapamil and Cardizem?
Suppresses impulse conduction through the AV node
52
What are interactions for Verapamil (Calan0 and Cardizem (Diltiazem)?
Elevated Digoxin levels
Higher risk of AV block
Beta blockers
53
What are the adverse effects of Verapamil (Calan) and Cardizem (Diltiazem)?
```
Bradycardia
AV Block
HF
Hypotension
Peripheral edema
Constipation
Dizziness (Due to vasodilation)
Headache
Edema
```
54
What do you want to monitor with CCB?
Vitals
| ECG
55
What kind of drug is adenosine (Adenocard)?
Antidysrhythmic
56
What is the regular dosage for Adenosine (Adenocard)?
6 mg
57
What is an indication for Adenosine (Adenocard)?
Termination of paroxysmal SVT
58
What is the MOA of Adenosine (Adenocard)?
Suppresses calcium dependent action potentials in the SA and AV node
59
What are interactions for Adenosine (Adenocard)?
Clients taking methylxanthines need larger doses of adenosine b/c methylxanthines block adenosine receptors
60
What are the short lived adverse effects of Adenosine (Adenocard)?
```
Bradycardia
Dyspnea
Hypotension
Facial flushing
Chest discomfort
```
61
What kind of drug is Digoxin (Lanoxin)?
Antidysrhythmic
62
What is the regular dose for Digoxin
0.125 mg - 0.5 mg
63
What are indications for Digoxin (Lanoxin)?
A-Fib
A-Flutter
SVT
64
What is the MOA of Digoxin
Suppresses dysrhythmias by decreasing conduction through the AV node and decreasing automaticity in the SA node
65
What are interactions for digoxin?
Concurrent diuretic use can lead to hypokalemia
66
what are the adverse effects of digoxin?
```
Dysrhythmias
Anorexia
N/V
Abdominal discomfort
Fatigue
Visual disturbances
```
67
What do ACE Inhibitors end in?
Pril
68
What are ACE Inhibitors used for?
Hypertension
HF
Diabetic neuropathy
MI
69
Name 4 ACE Inhibitors
Captopril (capoten)
Enalapril (vaster)
Lisinopril (Prinivil)
Ramipril (Altace)
70
ACE Inhibitors block the production of what?
Angiotensin II
71
ACE Inhibitors reduce the risk of cardiovascular mortality caused by what?
Hypertension
72
How do ACE Inhibitors effect HF patients?
Reduces cardiac afterload
Lowers arteriole tone
Dilates blood vessels in kidneys
Suppresses Aldosterone
73
How do ACE Inhibitors effect MI's?
Reduces the risk of developing HF
74
How does captopril effect Diabetic Neuropathy?
Slows progression by reducing Glomerular filtration pressure.
75
What are drugs that interact with ACE Inhibitors?
Diuretics
Antihypertensive drugs
Lithium
NSAIDs
76
What ACEI is approved for Diabetic retinopathy/
Enalopril
77
What ACEI's are approved for MI?
Captopril
Trandolopril
Lisinipril
78
Name an ARB
Losartan
79
What are indications for losartan?
Management of hypertension
| Prevention of stroke
80
What does Losartan bind too?
99% Protein bound
81
What is the Maintenance dose for Losartan?
25-100mg a day
82
What are the adverse effects of Losartan?
Diarrhea
| Angioedema
83
What are indications for Spironolactone?
Hypertension
| HF
84
What is the MOA of Spironolactone?
Blocks receptors for aldosterone
85
What are the adverse effects of Spironolactone?
```
Hyperkalemia
Deepening of the voice
Gynecomastia
Hirsutism
Impotence
Menstrual irregularities
```
86
What is Verapamil used for?
Angina
Hypertension
Dysrhythmias
87
What are the signs of Verapamil toxicity?
Hypotension
| Cardiotoxicity
88
What is Nifedipine used for?
Angina
| Hypertension
89
What is the MOA of nifedipine?
Blocks calcium channels in the VSM
| Vasodilation
90
What are the adverse effects of Nifedipine?
```
Facial flushing
Dizziness
H/A
Peripheral edema
Gingival hyperplasia
```
91
What are nursing considerations for Nifedipine?
Monitor Vitals
| Monitor for reflex tachycardia (BB combined to prevent)
92
Name 3 Vasodilators
Hydralazine
Minoxidil
Sodium Nitroprusside (Nitropress)
93
What is Hydralazine used for?
Selective dilation of arterioles
Hypertension
Hypertensive crisis
HF
94
What are the adverse effects of Hydralazine?
```
Reflex tachycardia
Increased blood volume
Headache
Dizziness
Weakness
Fatigue
```
95
What drugs interact with Hydralazine?
Antihypertensive drugs
96
What can hydralazine be combined with to manage sodium and water rentention and blood expansion?
BB and Diuretic
97
What is Minoxidil used for?
Severe symptomatic hypertension
| Hypertension associated with end-organ damage
98
What drugs should Minoxidil be administered with?
```
Beta blockers (Propranolol)
Diuretic (furosemide)
```
99
What are the adverse effects of Minoxidil?
Reflect tachycardia
Sodium and water retention
Hypertrichosis (Excessive hair growth anywhere on the body)
100
What drug is more intense than Hydralazine but causes more severe adverse reactions?
Minoxidil
101
What is Sodium Nitroprusside used for?
Hypertensive emergencies
| Controlled hypotension in surgery
102
What is the MOA of Sodium Nitroprusside
Release nitric oxide
103
What are the adverse effects of Sodium Nitroprusside?
Excessive hypotension
Cyanide poisoining
Thiocyanate toxicity
104
What are nursing considerations for Sodium Nitroprusside?
Monitor Vitals
Diuretic administration
Do not mix any other meds
105
What is Thiazide Diuretics used for?
HTN
HF
Diabetes Insipidus
106
What is the MOA of Thiazide?
Promotes urine production
107
Which diuretic keeps going regardless of the patients water percentage?
Loop Diuretic (Furosemide)
108
What diuretic is contraindicated in pregnant women?
Potassium sparing diuretics (Spironolactone)
109
Name four Inotropic drugs
Dopamine
Dobutamine
Digoxin
Milrinone
110
What is dopamine used for?
Shock
| Severe acute HF
111
What does dopamine interact with?
MAOI's
TCA's
General anesthetics
112
What are the adverse effectss of dopamine?
Tachycardia
Dysrhythmias
Anginal pain
Extravasation
113
What is Dobutamine used for?
Short term treatment for HF
114
What are the adverse effects of Dobutamine?
Tachycardia
| MI
115
What is Milrinone used for?
Short term therapy for severe HF
116
What are the adverse effects of Milrinone?
Dysrhythmias
| MI
117
What are nursing considerations for Inotropic drugs?
Cardiac monitoring
