Exam 2 Drugs Flashcards
(32 cards)
Nitroglycerin Indications
-↓ frequency and severity ofanginal attacks
-↑ in activity tolerance
potent artery vasodilator
•↑ blood flow to coronaryarteries–>↑ O2 supply
•↓ venous return to the heart(preload)
•↓ oxygen demand
NTG AE’s
AEs:
dizziness, HA, reflextachycardia, orthostatichypotension
NGT Implications
Sublingual:
• tabs stored in dark container: light affects how they work
• take at first sign of CP
• If pain not relieved after 1st dose, call EMS
• may repeat q5 mins. for 2 additional doses: pt can have 3 doses total
Ointment:
use dosing paper
• avoid contact with drug: goes on patient’s chest which is taped in place with date, time, initials ( the packet/med goes under this)
• rotate sites and remove all residual dose: repeated sites= reduced absorption
-longer acting
Selective Beta‐1 blockers: Action
• ↓ HR & ↓ force of contractiono ↓ O2 demand
• slows conduction through AVnode
• prolongs SA node recovery
Tx: angina, dysrhythmias,HTN, HF, MI
Selective Beta‐1 Blocker: metoprolol Indications
-HTN: ACE/ARB are first choice for HTN
- angina: helps this by slowing heart rate down and filling the coronary arteries
-↓ mortality w/recent MI
- HF
Metoprolol AE’s
AEs:
-bradycardia
- hypotension
-HF
-erectile dysfunction
-hypo/hyperglycemia
-bronchospasm, wheezing
Metoprolol Implementation
BBW:
- abrupt DC rebound HTN, dysrhythmias
Implementation:
- assess apical pulse
- hold if< 50 bpm or if arrhythmia occurs: for exams, if someone is at 75, takes a BB, drops to 52 and has symptoms, you still call the physician
Carvedilol & Labetolol Indications
- blocks beta‐1 receptors
- blocks beta‐2 receptors
- HF
- HTN
- angina
- left ventricular dysfunction after MI
Carvedilol & Labetolol AE’s
AEs:
-bradycardia
- hypotension
-HF
-erectile dysfunction
-hypo/hyperglycemia
-bronchospasm, wheezing
Carvedilol & Labetolol Contraindications
Contraindications:
-asthma,COPD
Diltiazem/Verapamil Indications
Non-dihydropyridine
- These are used to decrease the responsiveness of the AV Node and slow heartrate down; Most often used in SVT & Rapid A. Fibb ; patients who have a HR and contractility issue
-This Medication also causes more venous dilation–> important to ask about peripheral edema & weight, it will worsen
Indications:
o HTN
o angina
o supraventricular tachycardia
o rapid ventricular rates in Afib
Diltiazem/Verapamil AE’s
AE:
-arrhythmias
- hypotension: never give this if the patient is hypotensive OR if symptomatic
-HF
-sexual dysfunction: Erectile dysfunction common in meds that slow HR
Diltiazem/Verapamil Implementation
o assess BP and HR
o hold if SBP< 90 or HR< 50 bpm
Amlodipine Indications
Dihydropyridine
-Targets the vascular system (“Vascular System Selective “) and causes vasodilation; Amlodipine is typically the last resort drug and given as an adjunct with an ACE or ARB
Important to ask if they have peripheral edema or if intake and output is off
Indications:
o HTN
o angina
o migraines
o rapid ventricular rates in Afib
Amlodipine AE’s
AE:
-dizziness
-hypotension
- HA
Amlodipine D-D Interactions
Drug‐Drug:
• ↑ hypotension with anti‐HTN
• risk of bradycardia w/concurrent use of beta‐blockers
• Decreases effects of NSAIDs( and ASA): Especially after 2 weeks of use–> increased risk for renal failure & Improper absorption
• Increased toxicity risk with Lithium
-Do not give to patients with Aortic Stenosis
Amlodipine Implementation
Implementation:
o assess BP and HR
o hold if SBP < 90 or HR< 50 bpm
Digoxin Indications
This is a last resort medication because of the risk for toxicity; renal insufficiency can occur in something as simple as a UTI and this will put them at risk for digoxin toxicity
-Typically used for tachy heartrates or Rapid A.fibb that was unresponsive to Beta Blockers or Calcium Channel Blockers (most patients that get this have chronic A. Fibb)
• ↑ force of contraction
• allows ventricles to fill
• Reduces conduction velocity
• prolongs refractory period
Indication:
• adjunct to HF
• atrial fibrillation
Digoxin AE’s
AE:
-dysrhythmias
-hypotension
Digoxin Implementation
Implementation:
-pre‐assess apical pulse
-hold if < 60 bpm
-drug monitoring
Digoxin Monitoring & Antidote
Digoxin
o therapeutic level: 0.5‐2ng/ml
o hypoK+ and hypoMg+ increase the risk of toxicity: this is more related to renal insufficiency
ANTIDOTE: Digibind
Digoxin D-D Interactions
D‐D:
-Concurrent use w/ beta‐blockers and CCB –>bradycardia
Digoxin Toxicity Sxs
-nausea, visual disturbances (They will see green halos), bradycardia, HA, dizziness
o can either hold or tx toxicity based on severity of sxs
Digoxin Drug-Food Interactions
-ingesting large amts of bran
