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Flashcards in Cardio System(Pharm) Deck (77):
1

Nitroprusside(Nipride)

-Nitroprusside(Nipride)

2

Dopamine(Intropin)

-Dopamine(Intropin)

3

Epinephrine(Andrenalin)

-Epinephrine(Andrenalin)

4

Warfarin Na(Coumadin)

-Warfarin Na(Coumadin)

5

Amlodpine(Norvasc)

-Amlodpine(Norvasc)

6

Lisinopril(Prinivil)

-Lisinopril(Prinivil)

7

Captopril(Capoten)

-Captopril(Capoten)

8

Amiodarone Cl(Cordarone)

-Amiodarone Cl(Cordarone)

9

Ticlopidine(Ticlid)

-Ticlopidine(Ticlid)

10

Clopidogrel(Plavix)

-Clopidogrel(Plavix)

11

Simvastatin(Zocor)

-Simvastatin(Zocor)

12

Digoxin(Lanoxin)

-Digoxin(Lanoxin)
-cardiac glycoside
-cardiotonic
-po,im,iv
-loading dose(0.5-1.25 every 6-8hrs initially
-maintenance dose(0.125-0.25mg daily)
-0.8-2.0ng theraputic dig level

13

Procainamide(Pronestyl)

-Procainamide(Pronestyl)

14

Lidocaine(Xylocaine)

-Lidocaine(Xylocaine)

15

Isosorbide(Isordil)

-Isosorbide(Isordil)
-NItrate drug
-coronary vasodilator
-po,chewable,sublingual
-sublingual-under tongue, dont drink,smoke,eat after
-taking on empty stomach

16

Propanolol(Inderal)

-Propanolol(Inderal)

17

Dilitiazem(Cardizem)

-Dilitiazem(Cardizem)

18

Nifedipine(Procardia)

-Nifedipine(Procardia)

19

Verapamil(Isoptin)

-Verapamil(Isoptin)

20

Methyldopa(Aldomet)

-Methyldopa(Aldomet)

21

Enoxaprin(Lovenox)

-Enoxaprin(Lovenox)

22

Cardiac Glycosides(Cardtiotonics) ACTION:
DIGOXIN

action:
-act directly on the myocardium to slow down conduction and increase the force of myocardial contraction
-increase cardiac output through positive inotropic activity
-decrease conduction velocity through the SA/AV nodes
-result increase efficency and improved contraction of the heart muscle

23

Cardiac Glycosides(Cardtiotonics)
DIGOXIN
INDICATION:

indication:
-heart failure
-atrial fibrilation
-supraventricular tachycardia

24

Cardiac Glycosides(Cardtiotonics)
DIGOXIN(LANOXIN)
Route/Dose:

-po,im,iv
-digitalization: a series of doses given until the drug begins to exert full therapeutic effect
Dose:
-loading dose: 0.5-1.25mg every 6 to 8hrs initally
-maintainance dose: 0.125-0.25mg daily
-Theraputic dig level: 0.8-2.0ng
-over 2.0 is toxic

25

Cardiac Glycosides(Cardtiotonics)
DIGOXIN
Side effect:

Gi: early signs=N&V, anorexia,diarrhea

Neuro: headache,facial pain,apaty,drowsiness,disorientation,confusion,mental depression,delirium, convulsion

Visual: blurred,galo,diplopia,colored vision,yellow vision

Cardiac: bradycardia,tachycardia,extra systole,extra beats,atrial fibrilation and flutter

early signs of toxicity=nausea,vomitting, anorexia,diarrhea

later signs of toxicity=changes in mental status

26

Early signs of toxicity(Digoxin)

nausea,vomitting,anorexia,diarrhea

27

Later signs of toxicity(Digoxin)

changes in mental status

28

Factors that predispose patient to digoxin toxicity

-increase potassium
-decrease potassium
-decrease magnesium
-renal impairment
-recent mi and iv administration
-hypothyrodism-slows metabolism

29

Treatment of digoxin toxicity

1-withdraw drug(hold med)
2-treat the dysrrythmia with dilantin
3-atropine for bradycardia

antidote for digoxine is digibind not first line choice b/c drug is life threatening

30

Digoxin(Lanoxin) Nursing implication

-digoxin onset action 30min peak 2hrs, duration 2-6day
-i/o-weight-examine extremities for edema
-2lbs per day or 5lbs per week must be recorded
- B/P-respiration-sputum ausculate lungs
-assess for jugular vein distention=fluid retention
-assess apical heart rate one full minute
-take same time each day
-oral preparation w/o regards to meals
-avoid antacid
-decrease k levels, increase k levels
-poorly absorbed IM
-periodic EKG-electrolytes/kidney function

31

Digoxin(positive outcomes)Cardiac Glycosides(Cardtiotonics)

-increase urine output
-decrease weight
-decreae edema
-decrease SOB
-decrease fatigue

32

Digoxin(interactions)Cardiac Glycosides(Cardtiotonics)

-antibiotics:macrolides,tetracycline
-antifungal: ketoconozole
-NSAIDs
-Benzodiazepine: xanax
-antiarrythmic-verapermil
-antacids-kapectate
-thyroid hormone
-antileptics
-oral aminoglycoside
-antitubercular-rifampin
-antineoplastic

33

Phosphodiesterase Inhibitors(Action)
Amirone
Primacor

-positive inotropic activity
-vasodilating properties

34

Phosphodiesterase Inhibitors(indication)
Amirone
Primacor

-short term management of heart failure when digioxin doesnt work

35

Phosphodiesterase Inhibitors(adverse reaction)
Amirone
Primacor

-n/v
-arrythmias
-sudden death
-not first line treatment
-hypotension

36

Phosphodiesterase Inhibitors(drugs)
amirone
primacor

amirone
primacor-20-30x stronger than amirone

37

Atrial Natriuretic peptide hormone(ANP)
(Action)

-inhibit the renin angiotension aldosterone system
-binds w/ smooth vascular muscle-cause vasodilation
-reduce intravascular fluid volume

38

Atrial Natriuretic peptide hormone(ANP)(Indication)

-CHF w/ dyspnea at rest

39

Atrial Natriuretic peptide hormone(side effect)

-hypotension
-decrease kidney function
-drop in Bp

40

Antiarrythmic drug

-used to teat abnormal electrical activity in the heart.
-act in different ways to diminish or obliterate arrhythmias
-antiarrhythmic agents are divided into four classes/groups based on their similarity of their action

41

Sodium Channel Blockers(CLass 1)

-blocks movement of sodium into myocardial cells
use:
-anesthetic like effect on myocardial cells
-ventricular tachy arrthymia
-used only in benefits outweigh the risk
-patient who are dying

Drug: Moriazine HCL(Ethnozine)

42

Quinidine(Class 1A)(ACTION)

origin: cinchonobark
action: membrane stablizing effect on myocardial cells to decrease excitability

43

Quinidine(Class 1A)(indication)

used for:
-atrial and ventricular arrythmia
-first line treatment for malaria

44

Quinidine(Class 1A)(adverse effect)

-cinchinism=effect cns=neurotoxicity=gi/neuro effect
-gi: n/v, anorexia,diarrhea
-cardiac: hypotension, vtach,vfib,embolism
-hypersensitivity: mild to severe
-bone marrow suppression

45

Quinidine(Class 1A)(interaction)

-anticoagulants: increase bleeding
-antacid: decrease absorbtion
-digoxin,betablock,ca chan bloc: increase cardiac depression

46

Quinidine(Class 1A)(Nursing implication)

-monitor apical pulse
-po w/meals
-avoid citrus
-shell in stool-sustained release
-iv test dose-supine position
-monitor k level
-monitor serum levels=2-6mcg

47

Quindine drugs

Disopyramide
action: decrease rate of absorption
adr:atropine like
contraindication: atropine like
use: ventricular arrhythmia
dose: q6 100-150mg
atropine: treat bradycardia

procainamide
indication: first line drug of choice for vtach/vfib/pulselessness*
route:po,parental
dose:250-500mg
adr: cross sensitivity w/ procaine
gi irritation
drowsiness
dizziness
joint pain, butterfly rash(lupus like symptoms)
blood dyscaria

48

Lidocaine(Xylocaine)-Class 1B(action)

action:increase threshold of myocardial cells. decrease myocardial excitability

49

Lidocaine(Xylocaine)-Class 1B(indication)

-premature ventricular contraction post mi
-dose 100mg bolus,then 400mg in 500ml d5w infuse mg/kg/min

50

Lidocaine(Xylocaine)-Class 1B(adverse effects)

-neurological-dizzy,drowsy,confusion
-decrease heart rate
-resp depression
-gastrotoxic

51

Mexiletin-class 1b

po lidocaine
-all gastrotoxic
-all neuro toxic
-given po

52

phenytoin(dilatin)-class 1b-

antriarrythmic/hydantoin/anti-convulsant
-only to treat digoxin induced arrhythmia

53

Flecainidie-class 1C

action:decrease conduction in bundle of his and purkinjie fibers
indication: severe ventricular arrhythmia
route: po

54

Beta Blockers-class 2

1st/2nd generation
-2nd generation more cardia selective=decrease bronco spasm incidences/decrease risk of adverse effect
action: reduce sympathetic excitation in the heart by blocking cardiac cell response to epinephrine
indication/use:supraventricular arrhrythmia

55

Beta Blockers-class 2(drug)

-propranolol hcl(inderal)-
-10mg 3x day TID
-every 8hrs evenly spaced around the clock
-treatment plan for migraine
-indication: hypertension,angina,migraine,panic attack/stage freight, treat

-metoprolol tartrate(lopressor)

56

Beta Blockers-class 2(side effect)

-gi: n/v
-resp: tachypnea, wheezing, dyspnea,broncospasm
-cardiac: hypotension(inhibit renin-angiotension),bradycardia,cardiac arrhythmia,angina,chf
-endocrine:hypoglycemia
-reproductive-impotence
-circulatory: Raynauds phenomenom=spasms in blood vessels effecting circulation
-neuro-fatigue
-skin: rash, purtitus
-mood: mental depression
-interaction: drugs that decrease b/p an pulse
-contraindication: COPD,PVD, heart disease and diabetes

57

Potassium Channel Blockers(action)

action: lengthen action potential of myocardial cells

58

Potassium Channel Blockers(Drugs)

-Bretylium Tosylate-causes severe hypotension

-Amiodarone HCL(cordarone)
-vasodilating properties,decrease hr
-decrease contractibility of left ventricle
-negative inotropic
-side effect-sandy eyes,discoloration of skin blue/gray,photosensitivity,hypotension,pulmonary toxicity

-Adenosine(Adenocard)
-natural chemical found in all cells
-aides in transfer of energy
-increase release of prostaglandins
-decrease platale aggrgation(bleeding)
-drug of choice for: SVT

-i/v protect from crystallization

59

Calcium Channel Blocker(class 4)(action)

-block ca uptake by myocardial cells
-decrease force of contraction
-decrease cardiac output

60

Calcium Channel Blocker(class 4)(side effect)

-same as beta blocker
-hepatoxicity
gi: n/v, PLUS SWOLLEN GUMS
-resp: tachypnea, wheezing, dyspnea,broncospasm
-cardiac: hypotension(inhibit renin-angiotension),bradycardia,cardiac arrhythmia,angina,chf
-endocrine:hypoglycemia
-reproductive-impotence
-circulatory: Raynauds phenomenom=spasms in blood vessels effecting circulation
-neuro-fatigue
-skin: rash, purtitus
-mood: mental depression
-interaction: drugs that decrease b/p an pulse
-contraindication: COPD,PVD, heart disease and diabetes

61

Calcium Channel Blocker(class 4)(indication)

-use to treat (atypical)angina,hypotension,tachy-arrythmia

62

Calcium Channel Blocker(class 4)(drugs)

Amlodipine(norvasc)-
Diltiazem HCL(cardizem)-
Nifedipine(Procardia)-
Verapamil(Calan)-used for SVT-AFIB

63

Anticholinergic

-bradycardia
-prodysrhythmic effect of antiarrhythmic drug
drug used: atropine/anti-cholinergic
ADE: mad as hatter, red as a beat, blind as a bat, dry as bone
-elevated temp, confusion,blurry vision, flushed skin

64

Antianginal/vasodilators

types: 1)peripheral2)coronary
a.nitrates b.beta blockers c.calcium channel blocker

65

peripheral vaso dilators(action)

-relax the smooth muscle layer of atrerial blood vessels
-block alpha adrenegic receptors and stimulate beta adrenegic receptors
-dilate vascular bed in the femoral blood vessels
-inhibit platelet aggregation=risk for bleeding

66

peripheral vaso dilators(indication)

-intermittent claudication,PVD,Raynauds disease or burgers disease

67

peripheral vaso dilators(side effects)

-lowbp=hypotension
-every vasodilater has ability to drop bp
-flushing,tingling,dizziness,nervousness,postual hypotention, tachycardia, gi irritation, orthostatic hypotension

68

peripheral vaso dilators(interaction)

-betablockers-also hypertensive so cause greater hypertensive effect

69

peripheral vaso dilators(nursing implication)

-change in position slowly
-stop smoking b/c contricts vessels
-decrease cholesterol intake
-decrease caffeine intake=vaso contrictor
-caution pt with bleeding tendencies
-footcare: assess peripheral circulation: color,temp,pulses,edema,pain,foster circulation,pedal pulse cap refill in toes
-exercise to promote circulation

70

Coronary vaso dilator

indication: angina pectoris
action: opens coronary blood vessels, decrease cardiac workload, decrease cardiac oxygen consumption,increase risk for edema

71

Nitrate(coronary vasodilator)(Drug)

isosorbide dinitrate(isordil)-po, chewable,sublingual
-taken on empty stomach
-1 before - 2hrs after

72

Nitroglycerin(Sublingual)

ac. attack of angina pectoris
-take at 5min interval, if no relief call md and go back to hospital
-dose: 0.4mg
-pain disappear in 1-3 min
-throbbin headache indicates potency
-burning sensation under tongue=potency/freshness of drug
-drop BP, hypotension

73

Nitroglycerin(lingual spray)

-60-200meter dose
-indication-ac attack,hypertension

74

Nitroglycerin(patch)

-comes off at sleep to decrease tolerance

75

Nitroglycerin(IV)

-emergency treatment for high bp,vhf,post mi, and hypertension during cardiac surgery

76

Nitroglycein side effect/coranary vasodilator

3 H's
Headache,Hypotension,Increarse heart rate

77

Nitroglycein(interaction)

-tobacco,cold,atropine
-viagra(vaso dilator causes futher dilation)