Modules 3-4 Flashcards
(42 cards)
Hydrochlorothiazide
blocks reabsorption of Na and Chl in distal tubule; DECREASES PRELOAD (by removing fluid); need for HTN and HF; AE/SE: low electrolytes and HYPERcalcemia; monitor for Dig toxicity (r/t low K), monitor wt
Furosemide
block chl pump in the loop of Henle DECREASES PRELOAD; need for edema r/t HF, acute pulmonary edema, HTN; SE/AE: hypokalemia, HYPOcalcemia, high BG with DM,, elected BUN, creatinine and lipids, ototoxicity; monitor dig tox r/t low K, do not give two loops, if have sulfa allergy do not give monitor tw, bp and hydration
Spironolactone
potassium-sparing; blocks aldosterone; weak diuretic effect; need for edema r/t HF, SE/AE: HYPERkalemia, gynecomastia; do not give if have renal dz or anuria; ACE and ARB increase K monitor closely if greater than 5.3 w/hold med, monitor UOP
Lisinopril, enalapril or Captopril
ACE inhibitor; inhibits angiotensin 1 which increases bradykinin (promotes dilation and inflammation), dilates vessels (reduce afterload), reduces blood volume (decreases afterload); need HTN, HF, Acute MI, prevent MI, and helps with cardiac monitoring after MI; SE/AE: 1st dose hypotension, cough and angioedema (r/t bradykinin), high K, can cause renal failure with renal artery stenosis; teach get up slowly, limit K, monitor angioedema, must have renal fxn and check renal labs
Valsartan or Losartan
ARB (Does not block bradykinin) blocks angiotensin II (powerful vasoconstrictor), dilates, decreases aldosterone, and increases excretion of Na and Water (decreases preload and after load); Needs HTN, HF, MI, prevents MI, not as effective as ACE; SE/AE: 1st dose hypotension, angioedema, high K, renal failure can occur with renal artery stenosis
Nifedipine, verapamil, or diltiazem amlodipine
calcium channel blockers; block cal channels in heart reducing HR by blocking SA node, reduced contractility by suppressing AV node, and vsodilation )reduces afterload), increases coronary perfusion; need angina (coronary spasms), HTN (2nd line), cardiac dysrhytmias (not nifedipine); SE/AE: constipation (decreases ca in smooth muscle), bradycardia, hypotension, dizziness; fall risk r/t low BP, increases fiber/fluids, edema secondary to vasodialtion, grapefruit raises levels and dig tox r/t AV node suppresion; check HR before admin
Labetalol, atenolol, metoprolol
beta-blockers; decreases HR and contractility causing CO to decline, decreased afterload, longer use reduces PVR leading to decreased BP; Need labetalol for HTN crisis, 1st line for angina (exertional), HTN, cardiac dysrhythmias, MI, HF; SE/AE: masks low BG (blocks sns s/s); DO NOT admin with low HR; av blocks, asthma (can make worse), monitor BG
Atorvastatin
need for hypercholesterolemia, reduce risk of MI, angina, stroke ; SE/AE: well tolerated, HA, memory loss, rhabdomyolysis (tea color urine); if DC lipid levels go back high, does not work on pt who can not genetically synthesize LDL
Aspirin
inhibits COX1 (has to do w/ clotting pathways) prevents clots by blocking cox1 in platelets which reduces risk of MI and strokes; SE/AE: bleeding, gastric ulcers, tinnitis; check kid (nephrotoxic), check for GI bleed, contrain in bleeding disorders, DC 1 week before surgery, teach s/s of bleeding (blood in urine, black stool, coffee ground emesis), caution with other meds that increase bleeding
Clopidogrel
blocks things on platelet receptors and prevents ADP stimulated platelet aggregations; choice drug after coronary artery stents to reduce thrombitic events, MI, ischemic stroke, PAD; SE/AE: GI bleeding, bruising; DC 5 days before surgery, teach s/s of bleding
Heparin
suppresses coagulation by binding with antithrombin and inactivating clotting factor Xa; need for MI, PAD, PE, DVT, post-op prevention DVT, SE/AE: hemorrhage; given SubQ or IV; contain in bleeding disorders, monitor s/s bleeding (low BP, tachycardia, bruises, petechiae, hematomas, HA), DC if bleeding develops, monitor aPTT labs q4-6 rs, keep 1.5-2x normal; antidote protamine sulfate BUT if given puts at a high risk of clotting
cilostazol
inhibits platelet aggregation; vasodilation; need for intermittent claudication; SE/AE: HA, bleeding; avoid grapefruit and nicotine (nicotine vasoconstrictors), know how far they can walk in the beginning and after taking med;
Lisinopril, Enalapril or captopril HTN Specifics
inhibits angiotensin 1 (a vasoconstrictor) and increases bradykinin (vasodilator); decreases preload and afterload; SE: nagging cough, 1st dose hypotension (may need to DC diuretics a couple days), angioedema (tx w/ epi), hyperkalemia , renal failure in pts w/ renal artery stenosis
Alteplase and Tenecteplase
basically helps dissolve clots; needed for STEMI (NOT NONSTEMI), improves ventricular function, limits infarct size, and reducses mortality; AE/SE: bleeding, intracranial hemorrhage is biggest concern; HAS TO BE GIVEN 30 MINS OR LESS for the time between entering ED and starting fibrinolyis; start heparin before fibrinolytic, must also receive ASA, clopidgrel and heparin
Dobutamine
IV for acute HF; selective of beta 1; increases myocardial contractility and improved cardiac performance; need for STEMI with HF to improve short term CO; SE/AE: tachycardia, phlebitis; monitor BP, HR, UOP, peripheral pulses, monitor K, BUN, and creatine; interactions with beta blockers and nitroprusside
Digoxin
for chronic HF; inhibits na K pump which allows increased intracell Cal; increases contracility and lowers HR; 2nd line tx of HF; AE/SE: bradycardia, dig toxicity (with low K); monitor HR w/hold if< 60, monitor low K, NARROW therapeutic window, and antidote is digoxine immune Fab
NSAIDS (Diclofenac)
DO NOT GIVE ANY NSAID TO PT WITH HF it promotes Na retention and vasoconstriction which makes HF worse; can intensity toxicity of diuretics and ACE
Valsartan or losartan specifics for HTN
blocks angiotensin II; second choice for HTN; decreases preload and afterload; SE: angioedema, hyperkalemia; causes renal failure in pt with renal artery stenosis
Labetalol, atenonlol, metoprolol HTN Specific
LABETALOL FOR HTN CRISIS decreases HR and contractility causing CO decline, decreased afterload, and suppresses reflex tachycardia ; 1st line tx for angina; do not admin with low HR, AV blocks, or hypotension; caution with HF and asthma (unless it is metoprolol which is cardio specifc bc some act on beta 1 and 2)
Nifedipine, verapamil, diltiazem, or amlodipine HTN specifc
calcium channel blockers; reduces HR by blocking SA node (which decreases CO) and reduced contractility by AV node suppression and vasodilation; SPECIFICALLY helps with angina from coronary vasospasms; DO NOT GIVE WITH HF OR MI; SE: constipation, edema, dizziness, braduycardia, check HR and BP, masks hypoglycemia s/s; dig tox r/t AV node supprssion and NO grapefruit
HOWEVER: nifedipine CAN be given with beta blockers bc it does not mess with AV
Atorvastatin specific to HTN
tolerated well; may have HA, memory loss, rhabdomyolsis (tea urine); if DC lipids go back high
Aspirin HTN specific
cox2 has to do with pain cox1 effects the clotting pathways and prevents blood clots; used for protection; supresses platelet aggregation; take with full glass water contrain in anemia and bleeding disorders ;DC high dose 1 week before surgery ; check renal impair (is NSAID), monitor tinnitis (toxicity sign), reye syndrome in kids ; avoid high doses with ace/arbs
clopidogrel HTN specific
SPECIFICALLY coronary artery stents and PAD; DC 5 days prior to surgery
Cilostazol
INTERMITTENT CLAUDICATION; SE: HA, bleeding ; avoid grapefuit, and nicotine
