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Pharmacology N322 > Cardiovascular > Flashcards

Cardiovascular Flashcards

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1
Q

Nitrate NI

A

• AE: HA (primary), hypotension, reflex tachycardia, tolerance
• Teach Nitro Protocol for Administration**
o Can have systolic drop of 40.
o Always check BP and Pulse.
o Wait 5 minutes, still having chest pain-check BP and pulse again before giving more.
o If take one at home want to call provider and let them know.
o Light sensitive—needs to be stored in cool, dry, dark place, expires in 6 months.
• Contraindicated w/ phosphodiesterase Type 5 inhibitors (Viagra)— will cause massive hypotension and possible death.
• Monitor for drug tolerance—make sure they don’t take it for anxiety. Patch on in the morning and off at night. 12hours off.
• Wear gloves! Absorbed through skin.
• Can be IV, SL (sublingual), short or long acting tablet, topical patch/creams
• ST depression, ST elevation, new BBB give nitro. Maybe tombstone T’s
a. Looks like they may be having a heart attack.

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2
Q

Class 2 Beta blockers

A

Metoprolol

BP, HR, bronchoconstriction

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3
Q

Mannitol NI

A

Edema except in brain.
hold when Na >160
only given IV and ICU setting. ICP>20

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4
Q

Sympatholytics

A

Alpha 1 Adrenergic Blockers

Beta Adrenergic Blockers
(B1-heart, B2 lungs)

Adrenergic neuron Blockers

Centrally Acting Alpha 2 Agonists

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5
Q

Negative inotropes

A

Decrease contractility

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6
Q

Alpha/Beta blockers

A

-ilol, -alol

Carvedilol, labetalol

dizziness, bradycardia, hypotension

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7
Q

Loop diuretics SE

A

Same as thiazide plus:

Ototoxicity and nephrotoxicity

NSAID and ACE increase nephrotoxicity

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8
Q

Na channel IA blockers use

A

Quinidine-AF, Aflutter, Vt

Procainamide-VT

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9
Q

Adenosine use

A

SVT

first dose is 6mg given fast, can repeat if needed

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10
Q

Aldosterone antagonists

nursing implications

A

Hyperkalemia-hold if K hits 5. Kayexalate to reverse (poop out K)

renal impairment: BUN and Cr

CYP3A4: grapefruit, macrolides, HIV meds

Lithium toxicity

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11
Q

Thiazide labs

A

BUN, Cr, GFR

ineffective if GFR <20

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12
Q

Cardiac dysrhythmia Drugs and class

A 
Class 1: Sodium channel blockers
Class 2: Beta Blockers
Class3: K channel blockers
Class 4: Ca channel blockers
Class 5:  Adenosine, atropine, epinephrine
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13
Q

Diuretics

A

Thiazide diuretics, loop diuretics, Potassium sparing diuretics, osmotic diuretics,

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14
Q

Positive chronotrope

A

Increases HR

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15
Q

Clonidine NI

A

drowsiness, dry mouth, euphoric and hallucinogenic effects at high doses

Must be tapered or experience withdrawal symptoms

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16
Q

ACE inhibitors

A

-pril

Angioedema, Cough, hyperkalemia, major side effects

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17
Q

Non-DHP use

A

Angina: Verapamil but don’t usually give.

Cardiac dysrhythmias: Verapamil and diltiazem

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18
Q

Direct Acting Vasodilators

A

Hyrdalazine–arterial vasodilation

Nitroprusside: venous and arterial dilation (more for HTN emergencies

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19
Q

Class 1 sodium channel blockers

A

A: Quinidine(Heart block and thrombocytopenia, Procainamide 1:08
 IB: Lidocaine(confusion and drowsy, need drip slowed down, don’t stop it), Mexitil
 IC: flecainide (Tambocor)(worsening heart failure, sob, weakness); propafenone (Rythmol)(neutropenia)
 IA: Lidocaine most widely used in ICU
 1C: home use.
 Torsaudes possible side effect of all of them.

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20
Q

Direct Renin Inhibitors

A

Aliskiren

Cough and Hyperkalemia

Rarely prescribed, affects all aspects of RAAS

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21
Q

Centrally acting alpha 2 agonists

A

Clonidine

Severe HTN, severe pain, ADHD

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22
Q

digoxin NI

A

• AE or early toxicity: Anexoria, nausea, CNS effects-visual changes: discolorations or halos, arrhythmias.
Hold if HR less than 60.

If low potassium will cause dig toxicity
If too much K, likely dig blocking, lots of K floating around.

• Teach about toxicity and symptoms
• Dig Toxicity risks: K, CR/BUN, concurrent use with amiodarone, verapamil, or quinidine
• Watch with any drug causing hypokalemia (cardiac toxicity d/t K loss) –diuretics
• Therapeutic level: 0.5-2.0 ng/mL
• Given orally or IV, sometimes w/ IV loading doses then switch to oral
 Antidote: digoxin immune fab, (digibind)
 Give it and then treat symptoms.

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23
Q

Carvedilol use

A

HF: have CHF if on this drug

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24
Q

K sparing

A

Spironolactone

Hyperkalemia

Steroid effect:
dysmenorrhea, facial hair growth, gynecomastia, impotence.

Don’t use with severe renal failure, hyperkalemia and pregnancy

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25
Thiazide diuretics
Hydrochlorothiazide (HCTZ) HTN, CHF, liver ascites Hyponatremia, hypokalemia, hyperglycemia, hyperuricemia
26
Direct Acting Vasodilators use
HTN Hydralazine often used for African American pts with heart failure. Also common for use in end stage renal disease.
27
Negative chronotropes
Decreases HR
28
Statin NI
myopathy, Rhabdo, liver toxicity
29
sympathomimetics
dobutamine, dopamine, vasopressors dobutmaine: HF dopamine: Hypotension, HF, bradycardia
30
Antilipemic
HMG-CoA reductase inhibitors, Statins Lower LDL (high cholesterol) Atorvastatin higher likelihood of decreasing triglycerides. Can reduce CVA in high risk patients
31
Labetalol use
HTN: hypertensive crisis
32
What meds are all positive chronotropes?
Anticholinergics
33
Nitrates
Prevent or treat angina works on smooth muscle to promote vasodilation, decreases pre and afterload, less 02 demand
34
Na channel blockers IC
Flecainide, propafenone-SVT, AF, VT
35
Calcium channel blockers Nursing implications
* Hypotension: Monitor vitals * Peripheral Edema: of feet and legs, thought that these increase capillary permeability. * Tachycardia: from sudden improvement in BP * Bradycardia: common with non DHP; do no give in AV block * IR (Immediate)vs CR (controlled release): watch for facial flushing, dizziness * Gingival hyperplasia.
36
Fibrates
Gemfibrozil Reduce triglycerides, less effective for LDL, HDL Warfarin can cause higher levels of the the anticoagulant--Monitor INR
37
Alpha 1 Adrenergic Blockers
-zosin Rarely used for BP use: HTN and BPH implications: Ortho hypo, HA, nasal congestion. Don't give with sildenafil: extreme hypotension
38
beta blockers
Metoprolol: SVT, AF, AFlutter, ST
39
Calcium channel blockers | 2 types
Non-DHP Verapamil, Diltiazem DHP Amlodipine (-dipines)
40
Dopamine therapeutic use
 Stimulates Dopaminergic, Beta1 and Alpha1 receptors, but effects vary by dose. Positive Inotrope and Chronotropic Effects  Low dose: dilate vessels in heart, brain, kidneys, mesentery (dopaminergic activity) o Maybe kidney failure trying to improve perfusion to kidney  Higher dose: contractility and CO (beta 1 activity) o Positive inotrope and chronotrope  Highest dose: vasoconstriction (alpha 1 activity) o BP in the crapper o Sepsis 3L fluid then give. Gotta fill the tank o Won’t use if patient is tachycardic.
41
First drug to treat HTN
HCTZ
42
dopamine NI
* AE: HR, arrhythmias, angina * Don’t give with dehydration * Monitor BP, HR, UO-should see increased urine because of increased perfusion. * Monitor EKG * All given IV and titrated to desired effect. Peaks 10-15 mins after starting
43
digoxin therapeutic use
* Rate control w/ atrial arrhythmias | * Symptom management with HF
44
Epinephrine use
Asystole (also use dopamine), Afib, PEA rhythms
45
Statin Labs
CPK, LFT (baseline and periodic), cholesterol, liver and kidney CYP3A4-no grapefruit, macrolides, antifungal
46
Class 3: K channel blockers
Channel Blockers  amiodarone (Cordarone)(VFIB, VTACH, AFIB, Aflutter)(given after epinephrine  amiodarone:SE pulmonary fibrosis (check PFTs), never goes away, may get worse. Sign of toxicity. Can cause blue grey skin. Look like a smurf, doesn’t generally go away  Amiodarone can increase blood levels of several drugs including digoxin, phenytoin, diltiazem, warfarin, and statins. Increases chance of dig toxicity. ```  sotalol (Betapace): special properties of both beta blocker and potassium channel blocker o actually a class 2 and 3 ``` All can cause: All cause prolonged QT
47
Cardiac glycosides
Positive inotrope, negative chronotrope. Digoxin Sits on Na/k pump so K can’t enter, pushes Ca++ out. K and dig fight for same pump. If low K, digoxin will hog them all and become dig toxic. Lots of K floating around so can cause hyperkalemia.
48
Loop Diuretics
Most Potent Furosemide Renal, cardiac, liver failure. pulmonary edema HTN
49
DHP
Antihypertensive
50
Positive inotropes
Meds that increase contractility
51
Vasopressors
Nor Epi: raise blood pressure in shock states
52
Coated med
extended release, can't crush
53
Antianginal
Nitrates beta-blockers and Calcium channel blockers (non-DHP): used to help with symptoms (tachycardia)
54
Na Channel blockers IB
lidocaine- VF, VT
55
Phosphodiesterase inhibitors
Milrinone Positive inotrope CHF SE: dysrhythmia, hypotension, hypokalemia. IV only, must be on tele
56
ACE nursing implications
Hypotension-take pm if orthostatic hypotension Dry cough from bradykinin (stop med) Contraindicated for pts with renal failure also for dehydration NSAIDs decrease effectiveness* Pregnancy D, shouldn't take while breastfeeding. Should only be on one RAAS drug
57
Beta Adrenergic Blockers
-olol HTN, angina, dysrhythmias Can precipitate and treat HF
58
RAAS suppressants
ACE inhibitors, angiotensin receptor blockers (ARBS), Aldosterone Antagonists (K+ sparing diuretics), Direct renin Inhibitors, Ca+ channel blockers.
59
Atropine use
Bradycardia .5 first dose, repeat every 3-5 mins, max of 3 mg
60
Ca channel blockers
diltiazem, verapamil: Afib, Aflutter
61
``` Aldosterone Antagonists (potassium sparing diuretics) ```
Spironolactone, HCTZ Blocks aldosterone, (essentially testosterone as well) SE: Ed, impotence, loss of libido, feminizing features.
62
Beta adrenergic Blockers
Bronchoconstriction--caution asthma and COPD Bradycardia and Hypotension*** hypoglycemia
63
Loop diurteics labs
BUN, Cr, all electrolytes, especially Na and K
64
K channel blockers
Amiodarone, sotalol: Vfib, Vtach, Aflutter
65
Torsades treatment
Mg
66
Direct Acting Vasodilators
Increase HR and plapitations, SLE (lupus) syndrome Abrupt stop can cause severe HTN
67
Angiotensin Receptor Blockers (ARBS)
-sartan Less protective than ACE Similar side effects as ACE but no cough, angioedema is less common monitoring and teaching same as ACE
68
Osmotic Diuretics
Mannitol (only drug approved in US) Cerebral or ocular edema: decrease ICP and IOP rarely used for kidney protection in acute renal episode not used for HTN
69
digoxin antidote
Digibind (digoxin immune fab)

Pharmacology N322 (11 decks)

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