CHF drugs, Antianginals & Antidysrhythmics Flashcards
1
Q
Digoxin
A
- IV/PO
MOA:
- Positive inotrope (increased force & CO) better perfusion
- Negative chronotrope (decreased HR) lower workload
- Negative dromotrope (decreased conduction) less excitability
Indication:
- HF
- Dysrhythmia
Toxicity
- Monitor for bradycardia & hold for HR <60
- Yellow halos around objects, blurred, diplopia, dysrhythmias
- Narrow therapeutic window
Nursing Interventions (monitoring):
- Monitor K level, hypokalemia –> dig toxicity
- K-wasting diuretics –> decrease K –> dig toxicity
- K-sparing diuretics, ACE, ARB –> increased K –> decreased effect of digoxin
Patient Education:
- checking HR
- toxicity s/s
- avoid sildenafil
2
Q
Milrinone
A
- IV gtt
MOA:
- Positive inotrope (increased force = increased CO)
- Arteriodilator (decreased BP = decreased workload)
Indication:
- For 48-72 hour use to manage acute exacerbation of HF
- End-stage HF unresponsive to other meds
Side Effects:
- dysrhythmias
- Low BP
- Can also cause VT or sudden cardiac arrest –> do not use PO form for long periods of time
3
Q
Dopamine
A
- IV gtt
MOA:
- nonspecific adrenergic agonist (increased HR, vasoconstriction)
Indication:
- emergency med; HF, hypotension, shock
Side Effects:
- tachydysrhythimias
- MI
- N/V
- AKI
Nursing:
- Needs to be given via central line –> risk for extravasation
- Needs titration
- Hemodynamic monitoring (MAP, PP)
- Cardiac rhythm monitoring
- Taper dose before stopping
4
Q
Dobutamine
A
- IV gtt
MOA:
- Beta 1 agonist
- Positive inotrope (increase force)
- Positive chronotrope (increased HR)
Indication:
- Emergency med; HF, hypotension & shock
Adverse Reactions:
- MI
- Tachydysrhythmias
- Tremors
Nursing:
- Can be given via peripheral IV
- Taper dose before stopping
- Needs titration
- Hemodynamic monitoring (MAP, PP)
- Cardiac rhythm monitoring
5
Q
Epinephrine
A
Category Class:
- Nonselective adrenergic agonist- A1, B1, B2
MOA:
- increases BP & HR, opens airway
Indication:
- IM/SubQ: allergic reaction (anaphylaxis)
- IV: cardiac arrest, severe hypotension (shock)
- Aerosol: airway obstruction (bronchospasm)
Adverse reactions
- High risk for extravasation
- Antidote: phentolamine mesylate
Side effects
- Hypertension: pulmonary edema, dyspnea
- Tachycardia: dysrhythmias/palpitations
- Worsening prostate disease (BPH): urinary retention
- If it crosses BBB (large dose): tremors, restlessness, dizziness, fall
- Mydriasis: worsening glaucoma, photophobia
- Hypercoagulability: DVT, PE, CVA, MI
- Lower GI motility/secretions: poor absorption, N/V, constipation, xerostomia (dry mouth), hypoactive bowel sounds
- Blood shunting: acute kidney injury, ischemic bowel, cold skin
- Glycogenolysis: hyperglycemia particularly in DM
6
Q
Atropine
A
Category Class: anticholinergic
Indication:
- IV: symptomatic bradycardia
- PO drop: to reduce saliva (pre-op, palliative)
- Ophthalmic drop: to produce mydriasis & cycloplegia (pre-op)
- IM: reversal for cholinergic OD (OD with MG drugs)
Contraindication:
- Glaucoma
- BPH
- MG
Side effects, Adverse reactions:
- Tachycardia
- Palpitations
- Nasal congestion
- Photophobia
- Blurred vision
- Dry mouth and skin
- Constipation
- Urinary retention
- Impotence
- Memory impairment
- Coma
7
Q
Nitrates
A
- SL, translingual spray, IV gtt &, topical ointment (patch), PO
MOA:
- systemic vasodilation (decreases workload of heart) & coronary artery dilation (more O2)
- increases O2 supply & decreases O2 demand
Indication:
- Angina
Side Effects:
- Monitor for low BP, dizziness, fainting, HA, tachycardia & falls
Contraindications:
- glaucoma
- TBI
Nursing:
- Cardiac monitoring & VS
- Need ECG
- Labs should not delay administration
Patient Education:
- When having angina, stop activity, lie down & rest
- Take NTG SL or translingual spray, chew an aspirin
- Call 911 if pain is not resolved when the first NTG & 5 min of rest & take the second SL
- Avoid taking more than 3 SL
8
Q
Nitroglycerin
A
- SL & translingual spray
Indication:
- Angina
- Monitor BP/HR before & Q5min with SL dose
- SL tablets need to be kept in their own dark glass container
- Up to 6 months after opening or until expiration date if not opened
- Take SL dose prophylactically before strenuous activity
- Spray lasts 2 years
- Can cause severe throbbing HA
9
Q
Isosorbide Mononitrate & Isosorbide Dinitrate
A
- PO
Indication:
- Angina
- Do not stop taking abruptly
- Keep a log of angina (frequency, intensity, duration, location, quality)
- Do not crush or chew
10
Q
Nitropaste
A
- Topical ointment
Indication:
- Angina
- Can cause tolerance –> 8-12hrs nitrate free periods/day; do not need to cut the patch
- Apply to hairless area of chest, back, or abd
- Rotate to avoid skin irritation
- Wipe off the old ointment when replacing
- Avoid touching the ointment
- FALL RISK
11
Q
IV Nitroglycerin
A
- IV
Indication:
- Acute severe angina, HF
- Continuous infusion
- Special tubing from a glass vial
12
Q
Beta Blockers ( -lol)
A
- PO & IV
Medication:
- Propranolol
- Metoprolol
- Atenolol
- Carvedilol
- Labetalol
- Category Class: Beta-blocker (sleepy chicken)
MOA for Angina:
- Decreased HR (negative chronotrope) –> dec O2 demand
- Decreased excitability (negative dromotrope) –> dec dysrhythmia
- Decrease BP (preload & afterload) –> dec workload & O2 demand
Indication:
- Angina/MI, dysrhythmia, HTN, HF
Off Label Use:
- Glaucoma, migraine
Contraindication:
- Bradycardia, hypotension
- Call provider & hold for HR <60 or SBP <90
- Asthma, COPD
Side effects, Adverse reactions:
- Even selective beta-blockers may become nonselective at high dose (blocking beta 2 & bronchospasm)
- Monitor breath sounds (for worsening or new wheezing)
- Bradycardia, hypotension, dysrhythmia (FALL)
- Monitor trend of HR, BP, cardiac rhythm
- Postural hypotension and FALL (lie down if feeling dizzy, avoid sudden changes of position)
- Impotence, decreased libido (build rapport and discuss factors that may affect adherence)
Nursing Interventions (monitoring): - Masks hypoglycemia symptoms (palpitation)- monitory DM patients BG for asymptomatic hypoglycemia
Patient Education:
- Avoid stopping abruptly, wean off over 1-2 weeks
- At home keep a log HR/BP and associated s/s
13
Q
Ca Channel Blockers
A
Medication:
- Diltiazem
- Verapamil
Category Class:
- Nonspecific (vasculature & heart) no suffix
- Class IV
Indication:
- tachy-dysrhythmia
Side effects:
- Call the provider & hold for HR < 60 or SBP < 90
- Peripheral edema (daily weight, I/O)
- Dec BP –> FALL
- Dec BP –> monitor renal panel, I/O
- May cause ventricular dysrhythmia
Medication Administration:
- Cardiac rhythm must always be monitored
- Anticoagulation is always part of plan of care
- Continuous IV infusion eventually switched to PO
- IV push always slow (2-3 minutes)
- Exception: adenosine with 1/2 life <10 sec, push very fast & flush quickly with NS
Patient Education:
- Keep a log of VS, side effects at home and report to cardiologist
- Encourage adherence
Interactions (with drugs/food/UV light):
- Grapefruit juice
- Caffeine
- ETOH
- Tobacco
14
Q
Na Channel Blocker
A
Medications:
- procainamide
- flecainide
Side Effects:
- anticholinergic symptoms
- dysrhythmia
- bradycardia
- hypotension
- dizziness
- syncope
- fatigue
- edema
- impotence
- FALL RISK
Nursing:
- May cause Lupus symptoms
- Low blood cells –> monitor CBC, thrombocytopenia (bleeding), leukocytopenia
- Dysrhythimia –> monitor cardiac rhythm & VS
- Paresthesia & seizure precautions
Medication Administration:
- Cardiac rhythm must always be monitored
- Anticoagulation is always part of plan of care
- Continuous IV infusion eventually switched to PO
- IV push always slow (2-3 minutes)
- Exception: adenosine with 1/2 life <10 sec, push very fast & flush quickly with NS
Patient Education:
- Contact provider for joint pain
- Keep a log of VS, side effects at home and report to cardiologist
- Encourage adherence
Interactions (with drugs/food/UV light):
- Grapefruit juice
- Caffeine
- ETOH
- Tobacco
“All Lonely Boys Don’t Perform Sex”
15
Q
K Channel Blocker
A
Medications:
- Amiodarone
- Sotalol
Side Effects:
- dysrhythmia
- bradycardia
- hypotension
- dizziness
- syncope
- fatigue
- edema
- impotence
- photophobia
- FALL RISK
Nursing:
- Monitor for HF, pulmonary edema (dyspnea, crackles, edema)
- Monitor for brady-dysrhythimia (low HR, low BP)
- Photophobia may result to loss of vision
Medication Administration:
- Cardiac rhythm must always be monitored
- Anticoagulation is always part of plan of care
- Continuous IV infusion eventually switched to PO
- IV push always slow (2-3 minutes)
- Exception: adenosine with 1/2 life <10 sec, push very fast & flush quickly with NS
Patient Education:
- Keep a log of VS, side effects at home and report to cardiologist
- Encourage adherence
Interactions (with drugs/food/UV light):
- Grapefruit juice
- Caffeine
- ETOH
- Tobacco
“Hey Potassium Prevent Bradydysrhythmias”
