question

chronotropic

answer

+ chronotropic = increase in heart rate - chronotropic = decrease heart rate

question

inotropic

answer

+ inotropic = increase force of contraction - inotropic = decrease force of contraction

question

dromotropic

answer

+ dromotropic = increase in heart rhythm (conduction) - dromotropic = decrease in heart rhythm (conduction)

question

Preload

answer

amount of blood coming into the heart from superior and inferior vena cava

question

Afterload

answer

the resistance that the ventricles have to overcome to pump out the blood through the aorta.

question

ACE-Inhibitors (memory)

answer

A-pril A for ACE inhibitor and the names contain "-pril"

question

ACE Inhibitor method of action

answer

Decrease in blood flow (kidneys) signals --> release of renin --> angiotension --> enzyme --> angiotensen II --> increase in peripheral resistance --> increase in BP ACE Inhibitors block the enzyme and stops the process which leads to a reduction in BP

question

Angiotensin-Converting Enzyme Inhibitors (ACE) Actions

answer

Blocks ACE from converting angiotensin I to angiotensin II, leading to a decrease in blood pressure, a decrease in aldosterone production, and a small increase in serum potassium levels along with sodium and fluid loss

question

Angiotensin-Converting Enzyme Inhibitors (ACE) Contras

answer

Allergies Impaired renal function Pregnancy (birth defects) and lactation

question

Angiotensin-Converting Enzyme Inhibitors (ACE) Caution

answer

HF (don't want to slow down the heart too much)

question

ACE Inhibitor Prototype: Captopril: Indications

answer

Treatment of hypertension, CHF, diabetic nephropathy, left ventricular dysfunction after an MI

question

ACE Inhibitor Prototype: Captopril: Actions

answer

Blocks ACE from converting angiotensin I to angiotensin II, leading to a decrease in blood pressure, a decrease in aldosterone production, and a small increase in serum potassium levels along with sodium and fluid loss

question

ACE Inhibitor Prototype: Captopril: PK:

answer

Oral, onset 15 min, peak 30-90 min HL: 2 hours; excreted in urine

question

ACE Inhibitor Prototype: Captopril: AE/SE

answer

Tachycardia, MI, rash, pruritus, gastric irritation, aphthous ulcers, peptic ulcers, dysgeusia, proteinuria, bone marrow suppression, cough

question

ACE Inhibitors Nursing Considerations

answer

Assess blood pressure prior to administration Hold for BP 90-100/60 (Have to have BP before giving drug) Administer on an empty stomach 1 hour before or 2 hours after meals Watch for "first dose phenomenon" Prevent dehydration Decrease dose for renal failure Dry, hacking cough is a common adverse effect

question

The mechanism of action of an ACE inhibitor is the blocking of ACE from converting angiotensin I to angiotensin II. What does this cause? a. Decrease in serum potassium levels b. Decrease in aldosterone production c. Sodium and fluid loss d. Increase in blood pressure

answer

b. Decrease in aldosterone production Rationale: Blocks ACE from converting angiotensin I to angiotensin II, leading to a decrease in blood pressure, a decrease in aldosterone production, and a small increase in serum potassium levels along with sodium and fluid loss

question

The nurse is caring for a 27-year-old African American woman who was just prescribed an ACE inhibitor for management of her hypertension. What should you advise this patient about contraception? a. The use of spermicidal jellies is recommended. b. The minipill is the contraception method of choice. c. Use barrier contraceptives to prevent pregnancy while taking these drugs. d. No special precautions need to be taken.

answer

c. Use barrier contraceptives to prevent pregnancy while taking these drugs. Rationale: The safety for the use of these drugs during pregnancy has not been established. ACE inhibitors, ARBs, and renin inhibitors should not be used during pregnancy, and women of child-bearing age should be advised to use barrier contraceptives to prevent pregnancy while taking these drugs.

question

Angiotensin II Receptor Blockers: Prototype: Losartan: Indications

answer

Alone or as part of combination therapy for the treatment of hypertension; treatment of diabetic nephropathy with an elevated serum creatinine and proteinuria in patients with type 2 diabetes and hypertension

question

Angiotensin II Receptor Blockers: Prototype: Losartan: Actions

answer

Selectively blocks the binding of angiotensin II to specific tissue receptors found in the vascular smooth muscle and adrenal glands; blocks the vasoconstriction and release of aldosterone associated with the renin-angiotensin system

question

Angiotensin II Receptor Blockers: Prototype: Losartan: PK:

answer

Oral, Varies, 1-3 h, 24 h HL: 2 hours, then 6-9 hours; metabolized in the liver and excreted in urine and feces

question

Angiotensin II Receptor Blockers: Prototype: Losartan: AE/SE

answer

Dizziness, headache, diarrhea, abdominal pain, symptoms of upper respiratory tract infection, cough, back pain, fever, muscle weakness, hypotension (Liver and kidneys must be in good working order)

question

Angiotensin II Receptor Blockers Nursing Considerations

answer

Can take with food (irritating to GI tract) Prevent dehydration Do not use if pregnant or breastfeeding Use barrier contraceptives Discontinue immediately if pregnant Watch for syncope, cough, alopecia (hair loss)

question

Beta Blockers Mnemonic

answer

B = Bronchospasms - do NOT give to patients with bronchoconstrictive diseases E = Elicits decrease in cardiac output ; contractility T = Treat hypertension A = AV conduction decreases - treats arrhythmias Do NOT discontinue abruptly - causes rebound angina, confusion in elderly, psychosis

question

Beta Blockers Prototype: Propranolol: Indications

answer

Treatment of cardiac arrhythmias, especially supraventricular tachycardia; treatment of ventricular tachycardia induced by digitalis or catecholamines

question

Beta Blockers Prototype: Propranolol: Action

answer

Competitively blocks beta-adrenergic receptors in the heart and kidney; has a membrane-stabilizing effect and decreases the influence of the sympathetic nervous system

question

Beta Blockers Prototype: Propranolol: PK:

answer

Oral, 20-30 min, 60-90 min, 6-12 h IV, Immediate, 1 min, 4-6 h HL: 3-5 hours; metabolized in the liver and excreted in urine

question

Beta Blockers Prototype: Propranolol: AE/SE

answer

Bradycardia, CHF, cardiac arrhythmias, heart blocks, cerebrovascular accident (CVA), pulmonary edema, gastric pain, flatulence, nausea, vomiting, diarrhea, impotence, decreased exercise tolerance, antinuclear antibody (ANA) development

question

Beta Blockers Nursing Considerations

answer

Monitor BP, Pulse, and Respiratory status (you will want to know if the lings are filling up c fluid) Obtain medical history * asthma, COPD smoking - drugs cause loss of bronchodilation diabetics - monitor blood glucose frequently (due to the tendency of B blockers to increase blood glucose levels) Wean off drug over 2 weeks Teach to change positions slowly Explain change in sexual function Review laboratory tests: kidney, liver, electrolytes

question

Calcium Channel Blockers Actions

answer

Inhibits the movement of calcium ions across the membranes of cardiac and arterial muscle cells, depressing the impulse and leading to slowed conduction, decreased myocardial contractility, and dilation of arterioles, which lowers blood pressure and decreases myocardial oxygen consumption

question

Calcium Channel Blockers

answer

Allergy, heart block or sick sinus syndrome (don't want to decrease it if it is already too slow), renal or hepatic dysfunction, pregnancy, and lactation

question

Calcium Channel Blockers Prototype: Diltiazem: Indications

answer

Treatment of essential hypertension in the extended-release form

question

Calcium Channel Blockers Prototype: Diltiazem: Actions

answer

Inhibits the movement of calcium ions across the membranes of cardiac and arterial muscle cells, depressing the impulse and leading to slowed conduction, decreased myocardial contractility, and dilation of arterioles, which lowers blood pressure and decreases myocardial oxygen consumption

question

Calcium Channel Blockers Prototype: Diltiazem: PK:

answer

Oral/ER, 30-60 min, 6-11 h, 12 h HL: 5-7 hours; metabolized in the liver and excreted in urine

question

Calcium Channel Blockers Prototype: Diltiazem: AE/SE

answer

Dizziness, light-headedness, headache, peripheral edema, bradycardia, atrioventricular block, flushing, nausea

question

Calcium Channel Blockers Nursing Considerations

answer

Monitor BP, Pulse, cardiac status (are there any arrhythmias? listen to the apical and feel the radial pulse at the same time) Grapefruit juice increases drug to toxic level (interferes c P-450 enzyme system which is the livers system to detoxify drugs) Take 1 hour before or 2 hours after meals Prevent dehydration Wean off drug Do not use in pregnancy or breastfeeding African Americans respond better to CCBs

question

Vasodilators and Hypertensive Crisis:

answer

Diastolic BP > 120mmHg Relax vascular smooth muscle Monitor closely as sudden decrease in BP can cause cerebral ischemia & stroke (can cause not enough O2 to get to the heart/brain) Do NOT block reflex tachycardia when BP decreases and renin release = Na+ and H20 retention Contraindicated with pregnancy

question

Vasodilators: diazoxide (Hyperstat):

answer

IV for hospitalized patients with severe hypertension; increases blood glucose levels (not ideal for diabetics)

question

Vasodilators: hydralazine (Apresoline):

answer

Maintains increased renal blood flow, decreases peripheral vascular resistance (smooth muscle relaxant)

question

Vasodilators: minoxidil (Loniten):

answer

Used only for severe and unresponsive hypertension

question

Vasodilators: nitroprusside (Nitropress):

answer

Used for hypertensive crisis; maintain hypertension during surgery

question

Vasodilators: Prototype: Nitroprusside: Indications

answer

Hypertensive crisis, maintenance of controlled hypotension during anesthesia, acute CHF

question

Vasodilators: Prototype: Nitroprusside: Actions

answer

Acts directly on vascular smooth muscle to cause vasodilation and drop of blood pressure; does not inhibit cardiovascular reflexes and tachycardia; renin release will occur

question

Vasodilators: Prototype: Nitroprusside: PK:

answer

IV, 1-2 min, rapid, 1-10 min HL: 2 min; metabolized in the liver and excretion in urine

question

Vasodilators: Prototype: Nitroprusside: AE/SE

answer

Apprehension, headache, retrosternal pressure, palpitations, cyanide toxicity, diaphoresis, nausea, vomiting, abdominal pain, irritation at the injection site

question

Vasodilators Nursing Considerations

answer

nitroprusside sodium (Nitropress) - Light sensitive - Monitor for cyanide toxicity - see page 687 Suppresses iodine uptake - hypothyroidism Monitor BP closely during administration Prevent dehydration

question

Hypotension Causes

answer

Heart muscle is damaged and unable to pump effectively Severe blood loss, volume drops dramatically Extreme stress when body's levels of norepinephrine are depleted (Body is unable to respond to stimuli to raise blood pressure)

question

Antihypotensive Agents: Prototype: Midodrine: Indications

answer

Symptomatic treatment of orthostatic hypotension

question

Antihypotensive Agents: Prototype: Midodrine: Actions

answer

Activates alpha-adrenergic agonist receptors in arteries and veins to produce an increase in vascular tone and an increase in blood pressure Vasopressor Drug

question

Antihypotensive Agents: Prototype: Midodrine: PK:

answer

Absorbed from GI tract, metabolized in the liver, and excreted in the urine

question

Antihypotensive Agents: Prototype: Midodrine: Contras

answer

Supine hypertension, coronary artery disease (CAD), pheochromocytoma, and with urinary retention

question

Antihypotensive Agents: Prototype: Midodrine: Cautions

answer

Pregnancy and lactation Visual problems

question

Antihypotensive Agents: Prototype: Midodrine: AE/SE

answer

Related to stimulation of alpha-receptors

question

Antihypotensive Agents: Prototype: Midodrine: Drug-Drug

answer

Cardiac glycosides, beta blockers, alpha-adrenergic agents, and corticosteroids

question

Cardiac Glycosides

answer

Slows heart rate (- chronotropic) Increases force of myocardial contraction (+ inotropic) Decreases conduction velocity through the AV node (- dromotropic) Increases cardiac output and renal perfusion Increases urine output and decreased blood volume

question

Cardiac Glycosides Prototype: Digoxin:

answer

Treatment of CHF, atrial fibrillation

question

Cardiac Glycosides Prototype: Digoxin:

answer

Increases intracellular calcium and allows more calcium to enter the myocardial cell during depolarization; this causes a positive inotropic effect (increased force of contraction), increased renal perfusion with a diuretic effect and decrease in renin release, a negative chronotropic effect (slower heart rate), and slowed conduction through the atrioventricular (AV) node

question

Cardiac Glycosides Prototype: Digoxin:

answer

Oral, 30-120 min, 2-6 h, 6-8 days IV, 5-30 min, 1-5 h, 4-5 days HL: 30-40 hours; largely excreted unchanged in the urine

question

Cardiac Glycosides Prototype: Digoxin:

answer

Headache, weakness, drowsiness, visual disturbances, arrhythmias, GI upset

question

digoxin (Lanoxin, Lanoxicaps) Nursing Considerations

answer

Take apical pulse for 1 minute before administration. Withhold medication if apical pulse below parameters (Adult = 60, Child = 70, Infant = 90, newborn = 100) Administer loading or "digitalizing" dose Narrow therapeutic index (0.5 - 2.0 ng/ml - toxic ; 2.0 ng/ml)(must follow c labs to monitor) Monitor lab values - K+ Monitor I ; O, daily weight No IM injection, administer IV slowly over 5 minutes Antidote: Digoxin Immune Fab, Digibind, Digifab

question

Cardiac Glycosides Patient/Family Teaching

answer

Take radial pulse daily report 110 (at ;110 drug levels are either getting too toxic or not working) Immediately report adverse effects Check weight daily, report gain 2 lb in 2 days Administer before or after meals - not with food Diet - eat high K+ foods (wastes K+) Take as prescribed Do not take any OTC medications, esp. antacids (antacids interfere with absorption) Do not switch brands Do not breastfeed

question

Cardiac Glycosides (memory)

answer

Lizzy Diggy

question

Phosphodiesterase Inhibitors (Cardiotonic (inotropic) agents): inamrinone (Inocor):

answer

Approved only for use in patients with HF that has not responded to digoxin, diuretics, or vasodilators Contraindicated if allergy to bisulfites Precipitates if given with furosemide

question

Phosphodiesterase Inhibitors (Cardiotonic (inotropic) agents): milrinone (Primacor):

answer

Short-term management of HF in patients who are receiving digoxin and diuretics Contraindicated if allergy to bisulfites Precipitates if given with furosemide

question

Phosphodiesterase Inhibitor Prototype: Inamrinone:

answer

Short-term treatment of CHF in patients who have not responded to digitalis, diuretics, or vasodilators

question

Phosphodiesterase Inhibitor Prototype: Inamrinone:

answer

Blocks the enzyme phosphodiesterase, which leads to an increase in myocardial cell cAMP, which increases calcium levels in the cell, causing a stronger contraction and prolonged response to sympathetic stimulation; directly relaxes vascular smooth muscle

question

Phosphodiesterase Inhibitor Prototype: Inamrinone:

answer

IV, Immediate, 10 min, 2 h HL: 3.6-5.8 hours; metabolized in the liver and excreted in urine and feces

question

Phosphodiesterase Inhibitor Prototype: Inamrinone:

answer

Arrhythmias, hypotension, nausea, vomiting, thrombocytopenia (watch out for bruising and bleeding), pericarditis, pleuritis, fever, chest pain, burning at injection site

question

Phosphodiesterase Inhibitors Nursing Considerations

answer

Assess BP, Pulse, cardiac status Monitor for ventricular arrhythmias Protect from light Obtain daily weight, I ; O Monitor IV site Monitor platelet count (Watch for bruising, petechiae)

question

The nurse is caring for a patient who has presented at the emergency department with signs and symptoms of an acute MI. While making an initial assessment of this patient the nurse notes the patient has had adverse reactions to digoxin and a history of heart failure. What drug would the nurse be concerned about if it is ordered? a. furosemide (Lasix) b. milrinone (Primacor) c. propranolol (Inderal) d. aspirin

answer

b. milrinone (Primacor) Rationale: They are contraindicated in the following conditions: severe aortic or pulmonic valvular disease, which could be exacerbated by increased contraction; acute MI, which could be exacerbated by increased oxygen consumption and increased force of contraction; fluid volume deficit, which could be made worse by increased renal perfusion; and ventricular arrhythmias, which could be exacerbated by these drugs.

question

Angina:

answer

chest pain caused by decrease O2 to heart muscle

question

Antianginal Drugs

answer

Improve blood delivery to the heart muscle by dilating blood vessels Increasing the supply of oxygen Improve blood delivery to the heart muscle by decreasing the work of the heart Decreasing the demand for oxygen Nitrates Beta-Adrenergic Blockers Calcium Channel Blockers

question

Antianginal: Nitrates: Actions

answer

Act directly on smooth muscle to cause relaxation and depress muscle tone

question

Antianginal: Nitrates: PK:

answer

IV Sublingual Translingual Spray Transmucosal Tablet Oral, SR Tablet Topical Ointment Transdermal

question

Antianginal: Nitrates: Contras

answer

Allergy Severe anemia Head trauma or cerebral hemorrhage Pregnancy and lactation

question

Antianginal: Nitrates: Cautions

answer

Hepatic or renal disease Hypotension, hypovolemia, and conditions that limit cardiac output

question

Antianginal: Nitrates: Drug-Drug

answer

Do NOT administer with erectile dysfunction drugs (can cause fatal drop in blood pressure)

question

Anti-Anginals Prototype: Nitroglycerin: Indications

answer

Treatment of acute angina, prophylaxis of angina, intravenous treatment of angina unresponsive to beta-blockers or organic nitrates, perioperative hypertension, congestive heart failure (CHF) associated with acute MI; to produce controlled hypotension during surgery

question

Anti-Anginals Prototype: Nitroglycerin: Actions

answer

Relaxes vascular smooth muscle with a resultant decrease in venous return and decrease in arterial blood pressure, reducing the left ventricular workload and decreasing myocardial oxygen consumption

question

Anti-Anginals Prototype: Nitroglycerin: PK

answer

1-4 min; metabolized in the liver and excreted in urine (Very fast acting)

question

Anti-Anginals Prototype: Nitroglycerin: AE/SE

answer

Hypotension, headache, dizziness, tachycardia, rash, flushing, nausea, vomiting, sweating, chest pain

question

Nitrates Nursing Considerations

answer

Administer 1 tab SL every 5 min x 15 min No relief call health care provider Store dark vial Tablet should burn or "fizzle" Instruct not to swallow tablets Instruct not to chew/crush sustained-release Wear gloves for transdermal patch (can cause headache die to vasodilation) Spray translingual spray under tongue, not inhaled Wean off over 4-6 weeks

question

Nitrates Patient/Family Teaching

answer

Take at earliest sign of anginal pain Slow position changes Call 911 if pain unrelieved by 3 tablets - 5 minutes apart - over 15 minutes Take 5 -10 minutes prior to exercise Remove patches at bedtime, apply in AM Report blurred vision, dry mouth, chest pain, fainting Avoid alcohol, coffee, cigarettes Wear medic-alert bracelet Store in dark container, replace every 3 months (lose potency really quickly) Dress appropriately in cold weather - wear mask (cold gives chest pains - teach to stay in when very cold)

NUR 106 (UNIT 5) Cardiovascular Therapy: Non-Diuretic Cardiac Drugs – Flashcards

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