Cardiovascular Nursing part 3 Flashcards
Antihypertensive Drugs (Adrenergic receptors, ACE Inhibitors, ARBs, Diuretics, Vasodilators), Coronary Artery Disease (Angina, MI), Heart Failure, Cardiotonic Drugs, Sympathomimetic Drugs, Cardiac Glycosides (109 cards)
1
Q
drug for all kinds of hypertension
A
Antihypertensive Drugs
2
Q
stimulates receptors / SNS response
A
Adrenergic Agonist
3
Q
blocks receptors / SNS response
A
Adrenergic Antagonist
4
Q
Adrenergic Receptors
A
Alpha receptors
Beta receptors
5
Q
receptors that are excitatory
A
beta 1
alpha 1
6
Q
receptors that are inhibitory / relaxation
A
alpha 2
beta 2
7
Q
[Adrenergic Receptors]
- vasoconstriction
- mydriasis (iris constrict)
- urinary retention
A
alpha 1 receptor agonist
8
Q
[Adrenergic Receptors]
- vasodilation
- miosis (dilate)
- bladder emptying
A
alpha 1 receptor antagonist (BV)
- Prazosin
- Doxazosin
- Terazosin
*avoid warm shower, prolonged standing (orthostatic hypotension occurs)
9
Q
[Adrenergic Receptors]
CNS: ↓ NE flow = ↓SNS
*only agonist that decreases sympathetic NS
A
alpha 2 receptor agonist (CNS)
- Clonidine (Catapres)
-Methyldopa (Aldomet)
*centrally acting
s/e: Drowsiness (give at night)
10
Q
[Adrenergic Receptors]
CNS: ↑ NE flow = ↑SNS
A
alpha 2 receptor antagonist
11
Q
beta receptor in the heart
A
Beta 1
12
Q
beta receptor in the lungs
A
Beta 2
13
Q
[Adrenergic Receptors]
↑HR ↑contractility
A
beta 1 receptor agonist
14
Q
[Adrenergic Receptors]
↓HR ↓contractility
A
beta 1 receptor antagonist
15
Q
[Adrenergic Receptors]
Bronchodilation
A
beta 2 receptor agonist
16
Q
[Adrenergic Receptors]
Bronchoconstriction
A
beta 2 receptor antagonist
17
Q
Drugs to DECREASE SNS
A
- Alpha 1 antagonists (BV)
- Alpha 2 agonists (CNS)
- Betablockers
18
Q
antiHPN drugs that vasodilates and has side effect of COUGH
A
ACE Inhibitors “-pril”
- Captopril
-Quinapril
-Enalapril
19
Q
antiHPN drugs that vasodilates and has side effect of GI toxicity
A
ARBs “-sartan”
- Losartan
-Candesartan
- Telmisartan
20
Q
antiHPN drugs given during morning as it can cause increased urine output
A
Diuretics
- Thiazide: Metolazone, Hydrochlorothiazide
-Loop: Furosemide
21
Q
antiHPN drugs that directly relaxes smooth muscles of the blood vessels
A
Vasodilators
22
Q
[Vasodilators]
- Hydralazine (Apresoline)
-Nitrates (NTG, Isosorbide nitrate, Nitroprusside)
A
Direct Acting Vasodilators
23
Q
[Vasodilators]
1. Calcium Channel Blockers
>Short-acting CCB: Nifedipine, Amlodipine, Felodipine
> Long-acting CCB: Diltiazem, Verapamil
A
Indirect Acting Vasodilators
- ↓ Ca = ↓ contractility
24
Q
Sid effect of Calcium Channel Blockers “-pine”
A
Headache
25
also known as Ischemic Heart Disease (IHD)
Coronary Artery Disease (CAD)
26
artery that supply anterior and lateral wall of heart
LEFT Coronary Artery
27
artery that supply posterior and inferior wall of heart
RIGHT Coronary Artery
28
part of left coronary artery that is most affected in Myocardial Infarction
Left Anterior Descending (LAD)
29
etiology of Coronary Artery Disease / Ischemic HD
Atherosclerosis
30
Typical symptom of CAD/ IHD
Angina (due to ischemia)
31
2 venous drainage
1. Great Cardiac Vein
2. Middle Cardiac Vein
32
manifestation of CAD on elderly
ATYPICAL: confusion (not angina)
33
(+) Atherosclerosis gene
3x higher risk for CAD
34
chest pain or discomfort that most often occurs with activity or emotional stress; increased cardiac workload
Stable angina
35
condition in which your heart doesn't get enough blood flow and oxygen due to severe atherosclerosis
Unstable angina
36
chronic, severe pain (+) Levine sign
Refractory / Intractable Angina
37
condition in which your heart doesn't get enough blood flow and oxygen due to coronary vasospasm
Prinzmetal / Variant Angina
38
occurs when the heart temporarily doesn't receive enough blood (and thus oxygen), but the person with the oxygen-deprivation doesn't notice any effects ; asymptomatic
Silent Ischemia
39
-imbalance between O2 supply and cardiac workload
- reversible
-timing: <15mins
-Relieving factors: rest, NTG
Angina Pectoris
40
-ischemia and necrosis of cardiac cells
-irreversible
-timing: >30mins
-No relieving factors
Myocardial Infarction
41
PQRST
P-ain assessment, Position (location), Provocation
Q-uality (constant, heaviness, stabbing)
R-adiation, Relieving
S-everity (pain scale)
T-iming
42
Priority nursing diagnosis of Angina Pectoris
1. Ineffective myocardial tissue perfusion
2. Acute pain
3. Anxiety r/t fear of withdrawal (Restless)
4. Ineffective health maintenance
5. Non compliance
43
Management for Stable Angina
Independent NI:
REST!
(reduce cardiac workload)
44
Management for Unstable and Prinzmetal Angina
Dependent NI:
Nitroglycerin, Oxygen
(dilate blood vessels first before giving oxygen)
45
[Angina]
↑ Homocysteine level
↑ C - Reactive Protein
Risk for CAD
46
ECG finding present in Angina
T-wave inversion (myocardial injury/ischemia)
47
best time to perform ECG for angina and MI
During PAIN!
Angina: <15mins
MI: >30mins
48
Medical Management for Angina
1. Nitrogylcerin (fast onset)
2. Isosorbide Nitrate (Peripheral Vasodilators)
3. Betablocker
4. Calcium Channel Blockers (Peripheral Vasodilators)
5. Ranolazine (for chronic angina; not during acute attack)
↓ electrical activity = ↓ O2 demand
49
How to administer NTG
Sublingually, 3 doses, 5 mins interval ; during acute attack
Update:
NTG 1
NTG 2- Call 911
NTG 3 - Bring to hospital (even pain subsides)
50
Surgery for Angina
Percutaneous transluminal coronary angioplasty (PTCA)
also called percutaneous coronary intervention (PCI)
51
Priority nursing diagnosis for Myocardial Infarction
Acute Pain
52
Priority intervention for pain in myocardial infarction
Dependent Intervention: DOC: Morphine (Narcotics)
53
What must be monitored when taking Morphine?
Monitor Respiratory Rate
54
What is the most common side effect of Myocardial Infarction?
Premature Ventricular Contraction / Complex
55
What is the intervention when the nurse observes there is more than 6 Premature Ventricular Contraction in the ECG of a patient with MI?
Give antidysrhythmic drug
56
What ECG finding is an early sign of MI, seen in the zone of infarction?
ST Elevation
57
3 zones of Ischemia
- Zone of Ischemia (outermost)
- Zone of Injury (middle)
- Zone of Infarction (innermost)
58
What ECG finding is present on the zone of injury?
ST Depression
59
What ECG finding is present on the zone of ischemia?
T-wave inversion
60
2 Types of MI
STEMI - occurs when a ruptured plaque blocks a major artery completely
NSTEMI - atypical sign; caused by a block in a minor artery or a partial obstruction in a major artery
61
What ECG finding is a late sign of MI?
Pathological Q wave
(scar, old MI)
62
What is the most specific enzyme for MI?
CK-MB Isoenzyme
63
What is the most reliable / sensitive blood test for MI?
Troponin (protein)
64
What cardiac enzyme increases first 3-4 hours onset of pain?
1. Troponin
then CK-MB isoenzyme, Total CK
65
What does increased troponin indicate?
Myocardial infarction
66
What cardiac enzyme increases within 2 hours and is only suggestive?
Myoglobin
67
Management for MI
1. Morphine (Priority: PAIN CONTROL)
2. Oxygen
3. Thrombolytic Drugs -USA
4. Anti-Thrombotic / Antiplatelet / Anticoagulant
68
MONA TASS is for acute management of MI (not in prioritization order). What does it stand for?
Morphine
Oxygen
Nitroglycerin
Aspirin
Thrombolytic
Anticoagulant
Stool Softener
Sedatives
69
Surgical management for MI done within small vessels to treat coronary artery disease, the buildup of plaques in the arteries of the heart.
Coronary Artery Bypass Graft (CABG) / Heart Bypass Surgery
70
Condition wherein there is inability of the heart to pump effectively / cardiac decompensation
Heart Failure
71
Most common non-cardiac cause of Heart failure
COPD
72
Type of heart failure where:
1. Left ventricle fails
2. Right Ventricle fails
1. Left-sided HF
2. Right-sided HF
73
Type of Heart failure with respiratory symptoms such as pulmonary edema, progressive cough, orthopnea, crackles/rales, dyspnea, paroxysmal nocturnal dyspnea (PND)
Left-sided HF
74
Heart sound heard on a patient with Congestive HF
S3 Ventricular gallop (Lub-Dub-Dub)
75
[NYHA 4 Classification of HF]
- no limit on physical activity
-Risk for activity intolerance
Class I
76
[NYHA 4 Classification of HF]
- slight limitation of physical activity
-Activity Intolerance
Class II
77
[NYHA 4 Classification of HF]
- there is marked limitation
- Decreased Cardiac Output
Class III
78
[NYHA 4 Classification of HF]
-all s/sx manifests, unable to carry any physical activity
Class IV
79
What is the normal levels of Brain/Beta type Natriuretic Peptide (BNP)?
<100 pcg/mL
80
What is the levels of Brain/Beta type Natriuretic Peptide (BNP) in a patient with Congestive Heart Failure?
>400 - >800 pcg/mL
81
What is the PRIORITY for a patient with HF?
AIRWAY and Breathing Problems
82
Position for a patient with HF?
High fowler's
83
What must be monitored upon giving diuretics for a patient with HF?
Monitor Urine Output accurately
84
2 Nursing Diagnosis for Heart Failure
-Fluid Volume Excess
-Decreased Cardiac Output
85
[HF] Fluid Volume Excess Interventions
1. Restrict fluids
2. Restrict sodium
3. Monitor I and O
4. Monitor VS
5. Weigh pt daily
6. Oral Diuretics (adjunct - Furosemide, Spironolactone)
7. Monitor serum potassium level
86
what is the normal value of serum potassium?
3.5 - 5.0 mg/dL
87
[HF] Decreased Cardiac Output Goals
- to decrease cardiac workload
- to improve contractility
88
Interventions to Decrease Cardiac Workload in a patient with HF
1. Provide rest
2. avoid stress
3. support cardiac function
- ACE Inhibitors
-Angiotensin II Receptor Blockers
-Betablocker
-Calcium Channel Blocker
89
Interventions to increase Contractility of heart in a patient with HF
CARDIOTONIC DRUGS (Inotropic effect)
1. Sympathomimetic Drugs
2. Cardiac glycosides
3. Phosphodiesterase Inhibitor
90
What is inotropic effect of drugs?
Positive inotropic drugs help your heart beat with more force
91
What is contraindicated for drugs with inotropic effect / cardiotonic drugs?
Calcium channel blockers "-pine"
- Inotropic effect: increased release of Ca in cardiac cells
92
What is the effect of MILRINONE (IV), a Phosphodiesterase Inhibitor [cardiotonic drug]?
Peripheral Vasodilation
(not on HR)
93
What must be monitored for a patient taking Milrinone?
Monitor for HYPOTENSION !
(bc effect is peripheral vasodilation)
94
what is the mechanism of action of Sympathomimetic Drugs [cardiotonic drug]?
Agonists
PIPC
(+) inotropic = ↑ contractility
(+) chronotropic = ↑HR
95
Dobutamine and Dopamine is what type of cardiotonic drug?
Sympathomimetic Drugs
96
Why Sympathomimetic Drugs, such as dopamine and dobutamine, are given through infusion pumps?
Risk for Renal Failure
97
what is the mechanism of action of Cardiac Glycosides [cardiotonic drug]?
PINC
(+) inotropic = ↑ contractility
(-) chronotropic = ↓HR
98
2 examples of Cardiac Glycosides
-Digoxin
-Digitalis
99
What happens on (-) chronotropic effect?
there is Prolonged Repolarization = ↓HR
= Bradycardia
99
What is the contraindication for drugs with negative chronotropic effect?
Beta Blockers -olol
(-) Chronotropic effect: ↓HR
as betablockers also ↓HR
100
What drug is contraindicated to adjunct with Digoxin (oral), as if combined will cause prolong repolarization?
Amiodarone (antiarrhythmics)
It works directly on the heart tissue and will slow the nerve impulses in the heart.
101
Priority to monitor prior to administration of Digoxin
Heart Rate
102
Electrolyte imbalance that can cause digoxin toxicity
Hypokalemia!
- monitor serum K+
103
Therapeutic level of Digoxin
0.5 - 2.0 ng/mL
104
What must be monitored while taking Digoxin (to prevent toxicity)
- bradycardia
-GI toxicity (lack of apetite, n/v)
-ECG changes (dysrhythmia)
105
3 Drugs contraindicated while taking Digoxin
1. Calcium Channel blockers
2. Beta blockers
3. Amiodarone
106
Priority nursing intervention when noticed Digoxin toxicity
Withhold dose and Refer!
106
Hallmark Side Effect of Digoxin Toxicity
Visual Disturbances
-blurry vision
- halo vision
-yellow vision
107
Antidote for Digoxin Toxicity
Digibind
MOA: binds molecules of digoxin, making them unavailable for binding at their site of action on cells in the body
