cardiovascular agents Flashcards by Kalkidan Getu

Furosemide (Lasix) MOA

effects the ascending limb of loop of henle to block reabsorption of NA and Cl, prevents reabsorption of water

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Furosemide (Lasix) indication

Pulmonary edema from HF
edema non-responsive to other agents
HTN not controlled by other agents

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Furosemide (Lasix) adverse effects

decrease Na+ Cl K+ and BP
ototoxicity (ringing in ears)
dehydration with higher risk of thrombosis and emboli
ventricular dysrhythmias if used with digoxin

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Furosemide (Lasix) nursing considerations

close monitoring of I/O, vitals, weight, hearing and electrolytes
admin in morning-early afternoon
Slow IVP- give 10-2mg/min
educate on K+ rich sources in diet

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Hydrochlorothiazide (HCTZ) MOA

in distal convoluted tubule to block reabsorption of Na and Cl preventing water reabsorption

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Hydrochlorothiazide (HCTZ) indications

hypertension
edema secondary to HF, hepatic, or renal disease
diabetes insipidus
postmenopausal osteoporosis

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Hydrochlorothiazide (HCTZ) adverse effects

decrease Na+ Cl K+ and BP
dehydration with higher risk of thrombosis and emboli
ventricular dysrhythmias if used with digoxin

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Hydrochlorothiazide (HCTZ) nursing consideration

cant be used with patients with low GFR
watch I/O, vitals, weight, electrolyte
morning-afternoon administrations
education on K+ rich sources in diet

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Mannitol (Osmitrol) MOA

pulls fluid from interstitial space and moves it into vascular and extravascular space via osmosis

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Mannitol (Osmitrol) indications

Prophylaxis of renal failure with hypovolemic shock and severe hypotension
Reduction of intracranial and intraocular pressure

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Mannitol (Osmitrol) adverse effects

Edema, especially in patients with existing heart failure
Fluid & electrolyte imbalances

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Mannitol (Osmitrol) nursing considerations

use filter needles to avoid microscopic crystals
watch for changes in ICP
if urine output decreases severely, STOP

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Spironolactone (Aldactone) MOA

blocks action of aldosterone in distal nephron

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Spironolactone (Aldactone) indications

hypertension, often co-administered with K+ wasting diuretics
edema
HF

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Spironolactone (Aldactone) adverse effects

hyperkalemia
ednocrine effects menstrual irregularities, impotence, hirsutism and deepened voice

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Spironolactone (Aldactone) nursing considerations

Watch i/o, vitals, weight,a dn electrolytes
educate pt on K+ rich diet

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Kayexalate MOA

binds to K+ in intestine and excreted in stool

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Kayexalate adverse effects

Gastric irritation
N/V
Constipation OR diarrhea
Hypokalemia

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Kayexalate nursing considerations

Assess for bowel sounds/gastric motility prior to administering!
Monitor EKG
Monitor electrolytes

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Lisinopril (Zestril) MOA

ACE inhibitor

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Lisinopril (Zestril) indications

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Hypertension, heart failure, & post-MI therapy
Prevention of MI, CVA, and death in patients with high CV risk
Diabetic nephropathy

Lisinopril (Zestril) adverse effects

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First-dose hypotension
Cough
Angioedema
Hyperkalemia
Fetal injury

Lisinopril (Zestril) nursing considerations

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Monitor BP and electrolytes closely
Instruct patients to contact provider if cough and/or angioedema occurs
Daily weights

Losartan (Cozaar) MOA

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ARBs

Losartan (Cozaar) indications

Hypertension Reduce risk of stroke, possibly MI and death in patients with high CV risk Diabetic nephropathy and retinopathy

Losartan (Cozaar) adverse effects

Angioedema, although risk may be lower Fetal injury

Losartan (Cozaar) nurisng considerations

ARBs often used when ACEi are not tolerated due to cough Monitor BP closely, especially if on multiple agents Instruct patients to contact provider if angioedema occurs

Aliskiren (Tekturna) MOA

Binds with renin to inhibit cleavage of angiotensinogen into angiotensin I to reduce influence of entire RAAS direct renin inhibitor

Aliskiren (Tekturna) indication

HTN

Aliskiren (Tekturna) adverse effects

Generally well tolerated Diarrhea Low risk of hyperkalemia, angioedema, and cough Fetal injury and death

Aliskiren (Tekturna)

Close monitoring of I/O, vital signs, weight, and electrolytes, especially if on multiple anti-hypertensive agents

Nifedipine (Procardia) MOA

Blocks calcium channels on vascular smooth muscle, with minimal activity on heart

Nifedipine (Procardia) inidcations

angina pectoris and hypertension

Nifedipine (Procardia) adverse effects

Peripheral edema, flushing, headache, dizziness Reflex tachycardia

Nifedipine (Procardia) nursing considerations

Reflex tachycardia suppressed when combined with a beta blocker Diuretic for peripheral edema Assess BP and HR pre-administration

Verapamil (Calan) MOA

Blocks calcium channels on the heart and blood vessels

Verapamil (Calan) indications

angina pectoris, essential hypertension, and dysrhythmias

Verapamil (Calan) adverse effects

Constipation is most common Cardiosuppression with bradycardia, AV block, and decreased contractility with possible cardiotoxicity

Verapamil (Calan) nursing consideration

Monitor for interactions, particularly with other cardiac medications including digoxin and beta blockers, and grapefruit juice Assess BP and HR pre-administration Gastric lavage, activated charcoal, IVF, IV calcium gluconate, and Trendelenburg’s for toxicity

Hydralazine (Apresoline) MOA

Causes selective dilation of arterioles through actions on vascular smooth muscle to reduce peripheral resistance and blood pressure

Hydralazine (Apresoline) indications

Essential hypertension Hypertensive crisis Heart failure

Hydralazine (Apresoline) adverse effects

Reflex tachycardia Increased blood volume SLE-like syndrome

Hydralazine (Apresoline) nursing considerations

Combined with isosorbide dinitrate when used for treatment of heart failure !Co-administer with beta blocker to reduce of reflex tachycardia! Co-administer with diuretic to reduce risk of sodium and water retention Monitor vital signs closely, especially for excessive hypotension

Nitroprusside (Nipride/Nitropress) MOA

causes both venous and arteriolar dilation to decrease BP

Nitroprusside (Nipride/Nitropress) indications

Drug of choice for hypertensive emergencies Controlled hypotension during surgery to reduce bleeding

Nitroprusside (Nipride/Nitropress) adverse effects

Excessive hypotension Cyanide poisoning most likely in patients with liver disease Thiocyanate toxicity

Nitroprusside (Nipride/Nitropress) nursing consideration

minimal reflex tachycardia continuous vitals and ecg, frequent BP checks start infusion at 0.3-0.5 mcg/kg/min and tritate slowly co-admin with PO antihtn immediate effects trigger Na & water retention-manage with furosemide

Loop diuretic

severe HF watch closely for dig toxicity effective even with

Thiazide diuretics

produce modest diuresis not effective with

Postassium sparing diuretics

produce little diuresis used to counteract K+ loss from thiazide and loop diuretics for patients also taking ACE or ARBs- watch K+ levels

cardiovascular agents Flashcards

(50 cards)