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exam 1 Flashcards

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1
Q

Atropine (class/action/dose)

A

anticholinergic (or muscarinic antagonist)

blocks muscarinic (Ach) receptors causing decreased parasympathetic nervous system activation
dose: 0.5-1 mg IVP

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2
Q

Atropine (AE)

A

decreased GI/GU
dry mouth
mydriasis

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3
Q

Atropine (CI/Nurs)

A

CI: Hypersensitivity, Narrow-Angle Glaucoma, Severe Gastrointestinal Obstruction, Myasthenia Gravis, Prostatic Hypertrophy, Certain Cardiovascular Conditions

Nursing: Monitor Vital Signs, Assess for Side Effects, Monitoring for Toxicity, Temp regulation

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4
Q

Adenosine (class/action/ indication/dosage)

A

Class V antidysrhythmic
hyperpolarize cardiac membranes = no AP can occur
** set up for code, 6 mg, 12mg, 12mg**
Given for PAT, symptomatic narrow complex tachycardia,
(kinda stops the heart for a sec!)

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5
Q

Adenosine (AE)

A

flushing
transient hypotension
transient flat line
transient chest pain

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6
Q

Adenosine (CI/Nurs)

A

Admin: rapid IV push followed immediately by rapid saline flush,
CI: Hypersensitivity, Second- or Third-Degree AV Block, Sick Sinus Syndrome, Bronchoconstrictive Diseases

Nursing: Continuous ECG Monitoring, Vital Signs, Monitor for Respiratory Effects, patient is often positioned in a supine

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7
Q

Nitroglycerine (class/action)

A

Organic nitrates
Vasodilation → decreases preload (decreased O2 demand)
decreases coronary artery spasm

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8
Q

Nitroglycerine (AE)

A

headaches (cerebral vasodilation), postural hypotension, reflex tachycardia (can prevent with beta adrenergic antagonist or calcium channel antagonists)

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9
Q

Nitroglycerine (CI/Nurs)

A

sublingual ASAP
Q5mins, take another dose if no relief (up to 3 doses)
Can only give if BP adequate
*pt should be calling 911 as an outpatient after the first dose

Transdermal – rotate patch sites, take off at night bc tolerance can develop

Drug Interactions: other drugs that < BP, Sildenafil, Tadalafil, Veradenafil super contraindicated

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10
Q

Epinephrine (class/action)

A

catecholamine and a sympathomimetic drug and alpha- and beta-adrenergic agonist
alpha-1 receptors: Causes vasoconstriction → increased blood pressure.
Alpha 2: specific blood vessles that need to vasodilate, acts as a negative feedback loop
Beta-1 receptors: Increases heart rate and myocardial contractility.
Beta-2 receptors: Causes bronchodilation, useful in conditions like asthma or anaphylaxis

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11
Q

Epinephrine (AE)

A

Common:Tachycardia,
Hypertension,
Palpitations, Anxiety or nervousness, Tremors, Dizziness, Headache

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12
Q

Epinephrine (CI/Nurs)

A

CI: Absolute: Hypersensitivity to the drug
Relative Contraindications:Patients with severe hypertension, Tachyarrhythmias, Coronary artery disease, Hyperthyroidism, Diabetes mellitus, Glaucoma

Nursing: Monitor vital signs Assess for signs of an allergic reaction, Observe cardiac function, Monitor blood glucose levels

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13
Q

Norepinephrine (levophed) (AE)

A

Hypertension, Bradycardia, Arrhythmias, Peripheral ischemia, Anxiety or nervousness, Headache, metabolic acidosis

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14
Q

Norepinephrine (levophed) (class/action)

A

Sympathomimetic (Adrenergic Agonist)
Alpha-1 receptors: Causes vasoconstriction, leading to increased systemic vascular resistance and elevated blood pressure
Beta-1 receptors: Increases heart rate and myocardial contractility

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15
Q

Norepinephrine (levophed) (CI/nurs)

A

CI: Relative Contraindications:Hypovolemia, Patients with peripheral vascular disease, Recent myocardial infarction, Pregnancy

Nursing: Monitor vital signs, Assess perfusion, Monitor IV site (risk for tissue necrosis with extravasation), Phentolamine to reverse, Fluid resuscitation, Taper dosing carefully, Monitor urine output

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16
Q

Calcium Channel blockers dihydropyridines (mechanism and AE)

A

-dipine
calcium channels on vascular smooth muscle blocked → arteriole vasodilation → vasodilation and decreased vascular resistance
Hypotension, Dizziness or lightheadedness, Headache, Peripheral edema, Flushing, Reflex tachycardia

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17
Q

Calcium channel blockers, nondihydropyridines (mechanism and AE)

A

arteries (arterial vasodilation) AND on the heart (decreased contractility, HR, AV node conduction)
bradycardia, hypotension, AV block, HF, peripheral edema, constipation, liver/kidney disease > risk of toxicity

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18
Q

CCB (CI/Nurs)

A

Drug Interactions:
Beta blockers (additive cardiac depressant and elevates digoxin levels)
CI: Absolute: Severe hypotension or cardiogenic shock.
Second- or third-degree AV block, Sick sinus syndrome, Severe heart failure

Nursing: Monitor vital signs, Assess cardiac rhythm, Monitor for signs of heart failure, Avoid grapefruit juice, Titrate doses carefully, Assess renal and hepatic function

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19
Q

Digoxin (class/mechanism of action/ use)

A

cardiac glycoside
Na+/K+ ATPase inhibition = increased Na+ and therefore increased Ca++
= increased contractility
Uses: A flutter

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20
Q

Digoxin therapeutic level

A

0.5 - 2.0 ng/mL

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21
Q

digoxin (CI)

A

Contrindications: heart block
hypokalemia (can lead to drug toxicity)
WPW
advanced CKD
Acute MI
renal impairment

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22
Q

digoxin (Nurs)

A

Nursing: Monitor digoxin levels
Loading doses
Assess heart rate
Monitor for signs of toxicity: confusion, loss of appetite, nausea, vomiting, diarrhea, or vision problems.
Monitor electrolytes: Particularly monitor potassium, magnesium, and calcium levels
Renal function assessment
Monitor for drug interactions
Patient education: Instruct patients to report symptoms of toxicity

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23
Q

Beta blockers (mechanism of action/ use)

Study These Flashcards
A

-lol
block B1 receptors causing decreased HR, decreased contractility, and decreased conduction thru the AV node
Use: A fib, MI, cardiogenic shock

24
Q

Beta blockers (AE)

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A

AE: bradycardia, hypotension

25
Beta blockers (CI/Nurs)
CI: Absolute Contraindications: Severe bradycardia or heart block Cardiogenic shock. Severe heart failure Hypersensitivity to the drug or other beta-blockers. Nursing: Monitor blood pressure and heart rate Assess for signs of heart failure Monitor for bronchospasm Educate diabetic patients Do not abruptly discontinue Monitor renal and hepatic function Assess for depression
26
ACE inhibitors (drug/mechanism)
-pril inhibits ACE (angiotensin-converting enzyme) causing decreased blood volume (aldosterone decrease), vasodilation, decreased SNS adrenergic activity → decreased myocardial oxygen supply, prevention of CV remodeling
27
ACE-I (AE)
dry persistent cough, first dose hypotension, hyperkalemia, renal failure Rare: angioedema and neutropenia
28
ACE-I (CI/Nurs)
Note first dose hypotension can occur (limit other hypotension causing drugs and educate patients) avoid drugs that can elevate levels of K+ or that are heavily impacted by K+ levels Toxic to fetus – avoid in pregnancy caution in patients with renal issues
29
ARBs (drugs/mechanism)
-artan Angiotensin II receptor blocker Blocks the effects of angiotensin II at the receptor causing decreased blood volume (aldosterone decrease), vasodilation, decreased SNS adrenergic activity → decreased myocardial oxygen supply, prevention of CV remodeling; difference from ACE-I – doesn’t block kinase II → less side effects, and more aldosterone is released causing lower risk of hyperK+
30
ARBs (AE)
first dose hypotension, hyperkalemia (but lower risk than ACEs), renal failure, dizziness headache, fatigue Rare: angioedema and neutropenia
31
ARBS (CI/Nurs)
Note first dose hypotension can occur (limit other hypotension causing drugs and educate patients) avoid drugs that can elevate levels of K+ or that are heavily impacted by K+ levels Toxic to fetus – avoid in pregnancy caution in patients with renal issues Less evidence to reduce CV morbidity and mortality, so ACEs are first line
32
Heparin (Mechanism of action/class)
Anticoagulant Inhibition of Thrombin and Factor Xa: reducing the formation of fibrin and preventing clot formation
33
Heparin (AE)
Bleeding or easy bruising Pain or irritation at the injection site Elevated liver enzymes thrombocytopenia
34
aspirin (class/mechanism of action)
Nonsteroidal Anti-Inflammatory Drug (NSAID) irreversible (aka lasts entire lifetime of platelet), inhibition of Cyclooxygenase (COX) → decreased platelet aggregation/activation, decreases vasoconstriction
35
Heparin (CI/Nurs)
CI: Absolute Contraindications Severe Thrombocytopenia Hypersensitivity to Heparin Known allergic reactions to heparin or its components. Relative Contraindications: Recent Surgery History of HIT Renal or Hepatic Impairment Nursing Monitor Activated Partial Thromboplastin Time (aPTT): Monitor Platelet Counts Assess for Signs of Bleeding Injection Site Care Prepare for Reversal - protamine
36
Aspirin (AE)
Gastrointestinal symptoms Mild gastrointestinal bleeding or ulcers rarely: hemorrhagic stroke
37
Aspirin (CI/Nurs)
CI: Absolute Contraindications: Active Peptic Ulcer Disease Allergy to Aspirin or Salicylates: Known hypersensitivity or allergic reactions to aspirin or other salicylates Severe Renal or Hepatic Impairment Avoid use in children or adolescents with viral infections due to the risk of Reye's syndrome. Relative Contraindications: History of Gastrointestinal Bleeding or Ulcers Asthma Pregnancy Nursing Monitor for Gastrointestinal Symptoms: Assess for Signs of Allergic Reaction: Be vigilant for signs of hypersensitivity reactions, including rash, itching, or respiratory symptoms. Patient Education: Adherence to Dosage Bleeding Risks Avoid Alcohol Drug Interactions Monitor Renal and Hepatic Function Monitor Tinnitus or Salicylism:
38
Clopidigrel (Plavix) (class/mechanism)
Antiplatelet Agent Inhibition of ADP-Induced Platelet Aggregation: This inhibition reduces platelet activation and aggregation, decreasing the risk of clot formation
39
Clopidigrel (Plavix) (AE)
Bleeding or easy bruising Gastrointestinal symptoms Rash
40
Clopidigrel (Plavix) (CI/Nurs)
CI: Absolute Contraindications: Active Bleeding .Hypersensitivity to Clopidogrel: Known allergic reactions or hypersensitivity to clopidogrel or any of its components. Relative Contraindications: History of Bleeding Disorders Severe Liver Disease Pregnancy Nursing: Monitor for Signs of Bleeding Inform About Bleeding Risks: Adherence to Medication Avoid Certain Activities Drug Interactions Monitor for signs of hematologic reactions, including thrombocytopenia and TTP. Management of Gastrointestinal Symptoms
41
Protoamine Sulfate (class/mechanism)
Anticoagulant Reversal Agent Reversal of Heparin: It binds to heparin, neutralizing its anticoagulant effect. This is achieved through the formation of a stable, inactive heparin-protamine complex
42
Retaplase and altaplase (class and mechanism)
thrombolytic, shorter duration **best used in 30 mins of arrival to ED** binds plasminogen → plasmin → digests fibrin meshwork and degrades clotting factors
43
Retaplase and altaplase (AE and Nurs)
bleeding Nursing – minimize manipulation of the patient, avoid IM/sub Q injections, minimize invasive procedures, minimize use of concurrent anticoagulants,
44
Morphine sulfate (class/mechansim)
Opioid Analgesic produces most of its analgesic effects by binding to the mu-opioid receptor within the central nervous system (CNS) and the peripheral nervous system (PNS).
45
Morphine Sulfate (AE)
Nausea, vomiting, constipation. Drowsiness, dizziness, and lightheadedness. Respiratory Effects
46
Morphine Sulfate (CI/Nurs)
CI: Absolute Contraindications: Hypersensitivity: Known hypersensitivity or allergy to morphine or other opioids. Acute or Severe Asthma Severe Respiratory Depression Relative Contraindications: Pregnancy and Lactation Liver or Renal Impairment Concurrent Use with Other CNS Depressants Nursing: Monitoring Pain Relief, Respiratory Status, Gastrointestinal Effects, Dependence and Abuse
47
Dobutamine (class/action)
Beta 1 selective, alpha 1 if high dose Increases CO without increasing HR
48
Dobutamine (AE)
Hypertension Tachycardia Premature ventricular contractions Arrhythmias Shortness of breath
49
Dobutamine (CI/Nurs)
CI Tachycardia Hypersensitivity Can be difficult on kidneys Monitor BP, HR, CO and EXG
50
milrinone (Class/action)
Iontrope
51
Amiodarone (class/ mechanism)
Type III antidysrythmIc Blocks potassium exit to delay repolarization, increase action potential and effective refractory period Prolongs QT to allow more time for ventricles to fill
52
Amiodarone (use/dose)
150 mg bolus for PVCs 300 mg bolus if dead
53
Amiodarone (AE)
Pulmonary fibrosis Hypothyroidism Hepatotoxicity Corneal microdeposits Skin discoloration Prodysrhythmic: torsades, bradycardia, AV block
54
Amiodarone (CI/Nurs)
Side effects can begin up to 60 days after dose Long ½ life Baseline chest x-ray and pulmonary function tests Many drug interactions Not approved in pregnancy
55
Lidocaine (Class/ mechanism/use)
Class Ib antidysrhythmic Decreases action potential and effective refractory period Affects ischemic tissues Use: V tach, PVCs
56
Lidocaine (AE)
Toxicity at high doses: confusion, blurry vision, nausea, twitching, dizziness Signal from SA node is effective Seizures Cardiac arrest
57
Lidocaine (CI/Nurs)
Children under 3 Hypersensitivity Local anesthetic so be careful with dosing Monitor ECG, BP and respiratory status

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