Flashcards in Chapter 24 and 25 Deck (60):
The inability of the heart to pump enough blood to meet bodies demands
Increase the force of myocardial contractions
Positive inotropic drugs
Reduce the force of myocardial contractions
Negative inotropic drugs.
Increase the rate of the heart beat
Positive Chronotropic drugs
Decrease the heart rate
Negative Chronotropic drugs
Accelerate conduction through the heart
Positive Dromotropic drugs
Lower the conduction through the heart.
Negative Dromotropic drugs
Which side of the heart has problems with afterload and hypertension.
Left sided heart failur
What side of the heart causes lung problems and increased pressure inside the lungs.
Right sided heart failure
What happens when blood is not getting to targets appropriately?
Ventricles and heart will get bigger and bigger and will eventually lead to cardiacmegaly
Left sided heart failure signs and symptoms
pulmonary edema (this side is the congestive one)
S/S of Right sided heart failure
edema, G.I and hepatic congestion
Treatment of HF is usually based on.....
amount of symptoms that affect daily living skills
Helps with reducing fluid volume and decreasing blood pressure. Workload on heart is reduced increasing CO2. Usually used in combination with other drugs
Decrease cardiac workload by slowing HR and decrease BP
Increase cardiac output by increasing the force of myocardial contraction
First line drugs in the treatment of HF. Used for mild-moderate HF. Inhibits aldosterone secretion. Assists in diuresis lowering preload.
Prototype Ace Inhibitor drugs used:
Lisinopril (Prinivil, Zestril)
What loop diuretics are used for HF?
Lower force of contraction and oxygen demand caused by SNS. Lowers workload on a tired heart.
Beta Blocker drugs used for HF?
What are our natural body diuretics called and where are they located? get rid of excess fluid.
ANP (atria) & BNP (ventricles and other areas)
This encourages the body to diurese. Causes arteries and veins to vasodilate.
B Type Natriuretic Peptide
Synthetic version of BNP. Encourages normal diuresis effect of BNP. Given IV. Used in ICU for sever life threatening HF. Not given often
For more severe HF. Resulst in more calcium available for muscle contraction. Calms heart. Assists in vasodilation. Mainly used in acute HF. Given IVPB
Phosphodiesterase 3 Inhibitors
What should we not administer with Primacor?
other inotropic meds or give Lasix in same IV line- give separately.
Side effects Milrinone (Primacor)
headache (can be treated with analgesics)
Now used for limited to late stage HF. Safety margin of drug is narrow. Increases the strength of myocardial contraction. Release calcium ions that results in stronger contractions. Common rout PO, but also can be given IV
Adverse effects of Digoxin (Lanoxin)
ventricular dysrhythmias, malaise, dizziness, HA, vision problems (halos), n/v
Therapeutic range for Digoxin levels
Nursing responsibilities of Digoxin
take apical pulse daily
hold med if pulse falls below 60
give med at same time each day (don't double dose)
What is the antidote of Digoxin if over therapeutic range?
digoxin immune Fab
What other drugs and foods/supplements interact with Digoxin?
Do not take with ginseng
binds with bran- leads to altered absorption of drug if taken together
Any deviation from the normal rhythm of the heart. Many times an ectopic foci is causing issues.
Premature ventricular contraction
What electrolyte can make heart rhythms irregular
Ectopic foic in atria overide SA node to have ventricles beat. AV node is what stops impulses
Life threatening dysrhythmias
v-tach and v-fib
Contraction is happening
Heart is resting
A procedure used to shock a dysrhytmia (afib) back into NSR. Is timed. Shock them on R wave. Not as high of a shock.
Burn the right way for the conduction system to go for afib with ventricular stimulation.
Stop there heart and restart there heart. AED on them and then it shocks them.
Device that sends shock to heart to beat. Goes underneath the skin. Can be atrial and ventricular drive.
Looks like pacemaker. When a pt. goes into a lethal dysrhythmia and will shock heart internally like a defibrillator.
Internal Cardio defibrillator (ICD)
What will antidysrhythmic medications do for the heart?
Block conduction through heart
Alter ectopic foci activity
Largest group. Delays repolarization of the myocardium. Cardiac cells cannot be stimulated to contract. Slows impulses from over riding the SA node. Slows conduction of the heart. Used for atrial and ventricular conditions
Class 1a Sodium Channel Blockers
Procainamide (Pronestyl) IM/IV
Therapeutic range of Procainamide
4-8 mcg/mL (periodic serum levels)
Adverse effects for all sodium 1a class med
make new dysrhythmias
CNS changes (confusion to psychosis)
Class 1 B SCB. Decreases excitability in the ventricles. So they dont want to beat on their own. Minimal activity in the atria. Used for ventricular dysrhythmias only.
Adverse effects of Lidocaine
liver problems, twitching, convulsions, confusion
Class 1c SCB. Depresses cardiac conduction velocity. Used for atrial dysrhythmias and can prevent ventricular dysrhythmias.
Delays repolarizaiton of the myocardium-prolongs the action potential. Cardiac cells cannot be stimulated to contract again.
Class 3 Potassium blockers
Used for dysrhytmias that are difficult to treat or very severe dysrhytmias. Works on both the atria and the ventricles. Given PO, IV
Adverse effects of Amiodarone (Cordarone)
Bradycardia and hypotension, pneumonia-like symptoms, visual distrubances, rashes and photosensitivity-sunburn, avoid grapefruit
If taking Amiodarone what medication should we look ut for due to it potentially increasing INR by 50%?
Unclassified Antidysrhythmics. Slows conduction time through the AV node. Works well on supraventricular tachycardias (anything above ventricles). Very short half life.
Due to short half life of Adenosine, what do we as nurses have to do to make sure it gets to the heart?
Give fast in 1-2 seconds IV follwed by 20cc Heparin flush
What baseline measurements should we get prior to any of these medications
BP, pulse, I&O, and cardiac rhythm, monitor potassium levels