week 5 Flashcards
(46 cards)
Sodium Nitroprusside MOA
Acts directly on vascular smooth muscle to cause vasodilation and drop of BP; does not inhibit CV reflexes and tachycardia; renin release will occur
Sodium Nitroprusside indications
Severe HTN, maintenance of controlled hypotension during anesthesia or acute heart failure
Sodium Nitroprusside Nursing interventions
Protect from light
Monitor BP, HR, Rhythm, LOC
Toxicity: metabolizes to cyanide– monitor for change in LOC, delirium
Follow via lab draw
Nitroglycerine (NTG) MOA
Forms free radical nitric oxide (NO) which activates guanylate cyclase, resulting in an increase of guanosine 3’5’ monophosphate (cyclic GMP) in smooth muscle and other tissues
Nitroglycerine (NTG) indications
Perioperative HTN, angina, CHF in the setting of MI
Nitroglycerine (NTG) nursing interventions
Monitor for headache, chest pain, hypotension and reflex tachycardia
Monitor LOC
Milrinone indications
Cardiac support in patients with acute heart failure, pulmonary HTN, or chronic heart failure; Indicated for ST use for those who didn’t respond to digoxin or diuretics; limited to severe situations
Milrinone MOA
Positive inotrope and vasodilator; blocks enzye phosphodiesterase inhibitor leading to increase in myocardial cell cyclic adenosine monophosphate (cAMP), which increases calcium level in the cell, leading to increased contraction, vasodilation, oxygen consumption, and arrhythmias
milrinone nursing interventions
Monitor for DECREASEDE BP, HR and cardiac dysrhythmias, LOC
Urine output, skin color, assess for perfusion
Invasive: CO
Sudden Cardiac Death r/t toxicity
Dobutamine indications
Cardiac decompensation due to depressed contractility; low cardiac output
Dobutamine MOA
Inotropic; increases contractility, leading to decreased end-systolic volume and increase SV
Dobutamine nursing interventions
Monitor BP, HR, Cardiac Rhythm, LOC
Assess skin, capillary refill, urine output
Invasive: Monitor CO & CI
phenylephrine indications
Hypotension resulting primarily from vasodilation in settings such as shock or anesthesia
phenylephrine MOA
Activation of Alpha1 receptors, increasing systemic vascular resistance without an associated increase in contractility
phenylephrine nursing interventions
Monitor BP, HR and urine out.
Monitor IV site for infiltration and extravasation
Norepinephrine indications
Treatment of acute hypotensive states
norepinephrine MOA
Acts predominantly on alpha-adrenergic receptors to produce constriction of resistance; increasing systemic blood pressure and coronary artery blood flow
norepinephrine nursing interventions
Monitor blood pressure, heart rate and urine output
Monitor IV site for infiltration and extravasation
epinephrine indications
Treatment of hypotension associated w/shock; Emergency treatment of anaphylaxis; Produce a local vasoconstriction that prolongs the effects of local anesthetics
epinephrine MOA
binds w/ both α and β adrenergic receptors to cause vasoconstriction and vasodilation; smooth muscle contraction in blood vessels in skin, GI tract, kidney, and brain
epinephrine nursing interventions
Assess lung sounds, respiratory pattern, BP and HR
Can cause tachycardia, hypertension
May cause coronary ischemia, and arrhythmias.
epinephrine side effects
Pallor, tachycardia and palpitations, nervousness, muscle twitching, sweating, anxiety, insomnia, hypertension, headache and hyperglycemia.
dopamine indications
Correction of hemodynamic imbalances present in shock
dopamine MOA
Acts directly and by release of norepinephrine from sympathetic nerve terminals
