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Drugs affecting cardiovascular and vascular system Flashcards

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1
Q

ACE AND ARBS

A

Lisino-pril (Chill pill)
Lo-sartan (relax man)

Lowers BP only not HR
Ace = 1st choice
Arbs = 2nd choice
We can give ACE and ARBs if the HR is low since they only affect the BP

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2
Q

ACE AND ARBS mechanism of action

A

Both block or inhabit the RAAS system (renin angiotensin aldosterone system) which retains fluid
Aldosterone is blocked from adding sodium and water in and letting potassium out
(no sodium and water can get in, no potassium can get out)
Problem = Retaining too much potassium

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3
Q

ACE AND ARBS Precautions

A

Avoid Pregnant women (not baby safe)
Angioedema (airway risk) = Only ACE
Cough = Only ACE
Elevated Potassium - avoid potassium rich food, salt substitutes and liver

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4
Q

First Dose phenomenon

A

Don’t leave patients bedside and assess for any adverse reactions

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5
Q

Beta Blockers

A

Ends in LOL
AtenoLOL
Lowers HR and BP
always check BP and HR before giving

Neg Chronotopic (lower rate)
Neg Inotropic (less force)
Neg Dromotopic (less beats)
or
Decreases resistance
Decreases workload
Decreases cardiac output

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6
Q

Beta Blockers Side Effects

A

Blocks beta receptors 1 and 2

Bradycardia HR less than 60, less than 100 sys

Breathing Problems: bronchospasm, Wheezing - Not for asthma, COPD

Bad for HF patients = new Edema, worsening crackles in the lungs, rapid weight gain, new JVD = question Dr. Orders

Blood sugar masking, Beta blockers hide symptoms of low sugar. Hold is sugar is less than 70. Monitor sugars closely

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7
Q

Calcium Channel Blockers

A

Calms the Heart
Lowers HR and BP

NifediPINE
CardiZEM
VerapAMIL

Blocks the movement of calcium = relaxes blood vessels and takes the strain off the heart

Neg Chronotropic (lower rate)
Neg Inotropic (less force)
Neg Dromotropic (less. beats)

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8
Q

Calcium Channel Blockers Precautions

A

Count HR and BP do not give iim BP less than 90, hR less than 60
Change positions slowly
Bad headache = normal
Stop or slow any IV meds if there is a big drop in HR or BP, big drops can kill patients

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9
Q

Digoxin

A

Lowers HR, digs for a deeper contraction and increased contractility
Inotropic Drug
Given for Afib and HF

Nothing to do with BP
No orthostatic hypotension and no need to do slow position changed

Toxic side effects
Cardiac Glycoside

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10
Q

Digoxin Precautions

A

Check apical pulse for a full 60 seconds, hold if HR less than 60
Toxicity - over 2.0 = vision changes, nausea, dizziness, notify HCP immediately
Decreased kidney function = higher risk fir digoxin toxicity, monitor BUN and creatinine Over 1.3 = kidney Injury
Potassium below 3.5 = increase risk for digoxin toxicity (does not cause low potassium only increases the risk for toxicity)

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11
Q

Digoxin Toxicity

A

Max range 2.0
1st signs of toxicity
Anorexia
Nausea and vomiting
Vision changes (difficulty reading)

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12
Q

Which patient is most at risk for digoxin toxicity

A

Patient taking potassium wasting diuretics or Kidney failure patients

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13
Q

Dilators

A

Vasodilators
Nitroglycerin

Commonly given for chest pain but also works in HF patients to lower BP
Opens up vessels (dilates vessels to decrease vascular resistance) = Decreased BP

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14
Q

Top 5 vasodilators

A

Nitroglycerin
Nitroprusside
Hydralazine
Isosorbide (caution - not a diuretic)
Minoxidil (only severe HF)

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15
Q

Dilators Precautions

A

No Viagra “afil” Sildenafil = Death
Stop if Low BP less than 100 or drop by 30mmHg sys
Stop if patient has: lack of coordination, irritability, sweating, pallor

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16
Q

Dilators side Effects

A

Headache
Hypotension (slow position changes)
Hot flushing “facial redness)

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17
Q

Diuretics

A

Potassium wasting and sparing
#1 drug used for HF
Decrease eBP
Drain FLuid
Dehydrate the body

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18
Q

Potassium Wasting Diuretics

A

Caution: Hypokalemia 3.5 or less
Decreases potassium
Eat green lady veggies, melons and avocados
avoid liquorice root

Only give potassium wasting if potassium is normal 3.5-5.0

Loop #1 worsening HF
Worsening Crackles
New Edema in legs
Rapid Weight gain

FurosemIDE
TorsemIDE
BumetanIDE
Block reabsorption of sodium in kidneys, less sodium retained = less swelling

Thiazide
HydrochlorothiazIDE
Chlorothiadone

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19
Q

Potassium Sparing

A

Caution: Avoid potassium Avoid green leafy, melons and avocados, salt substitute

Spironolactone blocks aldosterone directly

Watch for hyperkalemia
Peaked T waves
ST elevation

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20
Q

Diuretics Precautions

A

Always check the BP: hold if BP low
Monitor and check BUN and Creatinine before
Potassium imbalances, monitor potassium and place on cardiac monitor

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21
Q

Diuretic Key tips

A

Take in the morning not a night
Slow position changes
Daily wights Report 2-3 lbs
Sunburn
low sodium diet

Avoid OCT meds - contain high amounts of sodium = swells the body
Cough and Flu
Antacids like tums
Acetaminophen
NSAIDS: naproxen and ibuprofen

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22
Q

Furosemide

A

1 drug for HF

if give to fast (IV push) can be
Ototoxic (ear rining)
Hypotension Low BP not HR

if given too much can be nephrotoxic - kidney toxic, always check creatinine and BUN labs
Hypokalmia

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23
Q

Antihypertensives

A

Ace
Arbs
Beta blockers
Calcium Channel Blockers
Dilators
Diuretics

Cause low BP and Orthostatic hypotension/dizziness when standing
Change positions slowly

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24
Q

Antidysrhythmics
Class 1: Sodium channel blockers

A

Procainamide
Lidocaine
Given for: V tach and V Fib

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25
Antidysrhythmics Class 2: Beta Blockers
Propranolol Given for: Hypertension, SVT, tachycardia Afib and Aflutter
26
Antidysrhythmics Class 3: Potassium channel blockers
Amidodarone Given for: V tach and V fib
27
Antidysrhythmics Class 4: Calcium channel blockers
Verapamil Diltiazem Nifedipine Given for: Hypertension, SVT, tachycardia Afib and Aflutter
28
Antidysrhythmics
Lower BP, reassess BP every hour Low oxygen to the brain, first sign = Dizziness Slow position changes
29
Other Drugs for Antidysrhythmics
Adenosine: Decreases HR given for: SVT Give fast: IV push 1-2 seconds, saline flush immediately after Digoxin: cardiac glycoside Given for: Afib Atropine (anticholinergic) Given for: symptomatic bradycardia (less than 60 that show signs of low oxygen = mental status changes, pallor) Push medication to make HR go crazy fast
30
Given for Atrial rhythms
Atropine Adenosine Beta Blockers Calcium Channel Blockers Digoxin
31
Given for Ventricular rhythms
Lidocaine Amiodarone Procainamide
32
Which drug causes Bradycardia?
Propanolol
33
What is the intended effect for Diltiazem?
Ventricular rate decreased from 160 to 70
34
Priority adverse effects to watch for when giving amlodipine?
Dizziness
35
Most important patient teaching when giving verapamil?
Slow position changes
36
A client on digoxin having difficulty reading a book or some type of vision problems
Toxicity for vision changes
37
Client on digoxin with a history of renal failure... key lab value to monitor
Creatinine over 1.3 = Bad kidney
38
Lidocaine Toxicity
Hypotension Any neurological changes is the first sign of toxicity, neurological checks are priority Only lasts a short while in the body - toxicity is easily treated
39
Amiodarone
Used 2nd if lidocaine doesn’t work Pulmonary toxicity - lung toxicity = Dry cough and sypnea Difficulty breathing while ambulating SOB report all of these to HCP
40
Which drugs do we teach slow position changes due to orthostatic Hypotension
Atenolol Amiodarone Amlodipine Diltiazem Furosemide
41
Antihypertensive Clondine
Given to lower BP when High BP is persistent and not responsive to other medications Very potent
42
Clondine Mechanism of Action
Alpha 2 antagonist To decrease the sympathetic response from the CNS inside the brain stem to the peripheral vessels resulting in decreases peripheral vascular resistance and vasodilation = decrease cardiac output, HR and BP Given either patch or will Priority: never stop taking abruptly can result in rebound hypertension leading to hypertension crisis and health Slowly tapper off over 2-4 days Teach slow position changes
43
Clonidine Precautions
Given either patch or pill Change patch every 7 days, apply patch to hairless intact skin on upper arm Sometimes used to treat ADHD Priority: never stop taking abruptly can result in rebound hypertension leading to hypertension crisis and health Slowly tapper off over 2-4 days Teach slow position changes
44
Clonidine Teaching
No Other CNS depressants No alcohol No antihistamines No sedatives No driving
45
INOtropic
Increase cardiac contractility Increased forceful contraction 3 D’d for Deep contraction Digoxin Dopamine Dobutamine
46
CHRONOtropic
Clock Neg chronos - Neg Tim = less beats per min = Lower HR Positive Chronos - positive time = more beats per minute = faster HR
47
DROMOtropic
Rhythm of Heart Beat Neg Dromotropic to stable heart rhythm Electrical impulses
48
Cholesterol lowering Agents
“Statin" Atorvastatin Simvastatin lovastatin Rosuvastatin
49
Cholesterol lowering Agents Mechanism of Action
Prevents cholesterol production in the liver by blocking an enzyme that is needed to make cholesterol Lowers BAD cholesterol Increases GOOD cholesterol
50
BAD Cholesterol
Total cholesterol 200 Triglyercides 150 LDL 100
51
GOOD cholesterol
HDL 40
52
Cholesterol Lowering Agents Indication
High cholesterol levels Hypercholesterolemia Hyperlipidemia
53
Cholesterol Lowering Agents Side effects
Liver Toxic Monitor liver labs (ALT and AST) do not give to patients with liver problems Muscle pain - muscle cramps, spams and aches, report to HCP Monitor Creatinine: muscle breakdown can clog kidneys Avoid grapefruit and st johns wort Take at night (dinner time or bed time)
54
MI Meds
Oxygen Aspirin Nitro Morphine
55
Nitro Precautions
3 doses Max 5 min apart No swallow: SL under the Tonge Headache and hypotension is normal take when sitting Call 911 if there is pain 5min after first dose
56
Morphine
Any chest pain after morphine indicates MI More pain = more tissue death
57
Clot Busters
Throbectomy Fibrinolytics x1 dose TPA Streptokinase (allergy risk) Bleed risk 8 hour window No sections (IV, SQ, IM, ABG) Never through central lines
58
After MI
Rest and prevent Clots Heparin IVL prevent and stabilize clot Heart Rest: Nitro IV drip Beta blockers CCB
59
Heparin
therapeutic Range PTT 46-70 (3x MAX range) Antitode: Protamine sulfate
60
Vasopressors Mechanism of Action
Vasopressors press on the vessel causing the blood pressure to increase and squeeze the oxygen back to the heart Given to increase BP During Cardiac Arrest During Shock and decreased perfusion Activate alpha and betas inside the heat and lining of the blood vessels
61
Alpha receptors
Alphas are responsible for constriction of the blood vessels so the blood squeezes back to the heart Alpha agonist: Increases Blood pressure Alpha Antagonist: Lowers the blood pressure
62
Beta receptors
Beta 1 = 1 heart Beta 1 agonist = faster heart rate, stronger pump, increased cardiac output Beta antagonist: Lower heart rate, less force Beta 2 = 2 lungs Dilation of lungs and bronchi Beta 2 agonist: Vasopressors and albuterol, opens up longs and vessels, lungs get more oxygen and organs get perfused. Since the blood vessels are dilated the blood pressure can drop
63
Main Vasopressors
Epinephrine Norephinephrine Vasopressin Dobutamine Dopamine
64
Epinephrine and Norepinephrine
EPI elevated blood pressure by activating the alpha 1receptorsto provide constriction Epinephrine (brand: adrenaline) Norepinephrine (brand: levophed) Given for severe low blood pressure for example septic shock Key difference: Epinephrine 1st priority in: Cardiac arrest (initiates heart contraction during cardiac arrest) A-systole PEA (Pulseless electrical activity) Also used as a 1st line drug in anaphylaxis
65
Phentolamine
used to treat dopamine and epinephrine extravasation (IV dislodged and leaks into the tissues) can cause burning and blistering Keep IV in place and give phentolamine immediatly
66
Vasopressin and Demopressin
Increases blood pressure Synthetic ADH (antidiuretic hormone) does not affect the alpha and betas Increases fluid in the body to increase blood pressure by making you stop urinating Demopression: Given for Diabetes Insipidus
67
Dobutamine and Dopamine
Given for a deeper contraction inotropic = increases cardiac contractility and increased forceful contraction Treatment for cariogenic shock Assess BP hourly Monitor Vital signs Dopamine: Activates alpha 1 and beta 1 receptors Therapeutic effects: Low doses act on dopamine receptors Moderate doses act on beta 1 receptors High doses act on alpha 1 and beta 1 receptors Assess IV site hourly for s/s of infiltration
68
Dopamine Given for a patient with hypotension what indicates effectiveness
Increased cardiac output

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