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62 Cards in this Set

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Angina/Coronary heart disease

Episode of chest pain caused by demand for oxygenated blood for body is greater than supply


Caused by: atherosclerotic plaque in coronary arteries, high levels of catecholamines


Results in: MI or heart attack

Types of Angina (3)

1. Stable


2. Variant


3. Unstable

Stable Angina

chest pain, squeezing, suffocating, may go down arm or up into jaw


Nurse: women also see fatigue and SOB

Variant Angina

spasms of coronary artery during rest


Nurse: pain relieved by nitroglycerin

Unstable Angina

common/intense chest pain, spasms, squeezing, suffocating due to advanced coronary artery disease

Nitrates

Action: relax smooth muscle in blood vessels, vasodialator, decrease pre+afterload


Use: used for/prophylactically for angina and MI


Adverse: HA, hypotension, dizziness, N/V, flushing, tachycardia


Nurse: wear gloves, hold ptn at 30 pts less than normal systolic, no beta blockers of ED meds, telemetry these patients


Teach: for short term attacks take 3 pills, 5 mins apart. call EMS if condition doesn't improve. no smoke/ETOH. sit/lie down when taking

3 types of Nitrates

1. NTG


2. Isordil - long term prophylactic


3. Imdur - sustained release taken once/day

NTG

Type: Nitrate (most common)


Use: angina, MI (for and prophylactic)


Given: pill under tongue, cream, patch, IV, spray


Nurse: Patch 12 hrs on/off, rotate site. Pills must be stored in original dark container. should fizzle under tongue. if they don't then they are expired.

Beta 1 blockers

Action: decrease energy demands of heart


Use: chronic stable angina, MI, HTN, dysrhythmia


Adverse: hypoglycemia


Nurse: monitor VS's, change positions slowly, taper dose, avoid hot tubs/hot showers, saunas, no ETOH, want HR > 60.


Types: Tenormin (improves MI survival rate) and Lopressor

Normal cholesterol levels (4)

Total: <200/dL


LDL: <100


HDL: >60 (problem if under 40)


Tiglycerides: <150

High cholesterol is linked to:

arteriosclerosis, HTN, CAD, PVD, MI


-agents to lower lipids attempt to lower lipid/triglyceride levels in serum

Lipitor and Zocor

Type: lipid lowering agent


Class: HMG-COA reductase inhibitor (aka statin)


Action: block cholesterol synthesis in liver


Use: lower LDL by 30-40%, maintain HDL


Adverse: constipation, abd distention, burping


Contra: don't give to ptns with liver failure


Nurse: first line cholesterol drugs, give at night, don't get pregnant, restrict ETOH, starts in 1-2 weeks, max effect in 4-6 weeks

Questran

Type: lipid lowering agent


Class: bile and acid sequestrants


Action: inhibit or increase excretion of bile in GI


Adverse: constipation, bloating, farting


Contra: no ptns with bile obstruction disease


Nurse: take powder in mixed with food/drink before meal, increase fiber

Lopid

Type: lipid lowering agent


Class: fabric acid derivatives


Action: reduce plasma triglycerides by increasing enzyme lipoprotein lipase


Use: short term for hyperlipidemia patients who fail diet


Adverse: abd pain, diarrhea,


Nurse: signs of gall stones, need fiber and fluid

Zetia

Type: lipid lowering agent


Class: cholesterol absorption inhibitor


Action: acts in small intestine


Nurse: used in adjunct with statins for those who are intolerant to other therapies

What is heart failure and what are the symptoms?

Heart not being able to meet the demands of the body


Symptoms: dyspnea, fatigue, ankle edema, jugular vein distention, pulmonary edema


What are the 6 classes of drugs that treat heart failure?

1. Ace inhibitors


2. angiotensin II blockers (ARBS)


3. Phospodiesterase inhibitors


4. Cardiac glycocides


5. Diuretics


6. beta blockers

Lisinopril and Captopril

Type: drug for heart failure


Class: ACE inhibitor


Action: inhibits Angiotensin I to II


Use: heart failure, HTN


Adverse: hypotension, renal tubular damage, cough, angioedema


Contra: no renal disorder or pregnant patients


Nurse: monitor weight, I&O, rebound hypertension w/ abrupt stop, monitor K, no NSAIDS

What is the function of Angiotensin II?

potent vasoconstrictor

2 cool things about ACE inhibitors

1. they are heart protective following an MI - stop progression of ventricular hypertrophy


2. protect kidney in diabetics when there is no existing kidney failure

Losartan and Valsartan

Type: drugs for heart failure


Class: ARBS


Action: compete w/ Angiotensin II for binding site


Adverse: hypotension, less cough


Conatra: no liver failure or pregnant patients


Nurse: monitor weight, I&O, rebound hypertension w/ abrupt stop, monitor K, no NSAIDS

Netrecor

Type: drug for heart failure


Class: B-type natriuretic peptide


Action: increase CO, SV and contraction without altering HR/BP


Use: given IV in ICU for Acute heart failure


Adverse: hypotension, dysrhythmias


Nurse: Monitor BNP

Primacor and Inocor

Type: drug for heart failure


Class: Phospodiesterase inhibitor


Action: vasodilation to decrease pre+afterload, inhibit action phosphodiesterase enzyme


Use: given in ICU for acute heart failure only after other treatment failure


Adverse: hypotension, hysrhythmias


Inocor can cause thrombocytopenia

Digoxin

Type: oldest heart failure drug


Class: Cardiac glycocides


Action: slow HR and increase force of contrations


Use: heart failure, tachyarrhythmias


Adverse: bradycardia, heart block


Nurse: no new patients RX'd this drug b/c not shown to decrease mortality, start with loading dose, hold HR <60

Cardiac Glycocides Toxicity symptoms

-anorexia, hypokalemia, yellow/green eyes


-Elderly more likely to experience toxicity


-Normal blood level of drug should be .5-2 ng/mL

Bidil

-Combination of Apresline/isosorbide (vasodilators)


-shown to treat heart failure and HTN in African american population

What is a Dysrhythmia, what are the 5 types and which are life threatening?

Disturbance in the hearts electrical conduction


1. Sinus


2. Atrial


3. Nodal


4. Ventricular (LT)


5. Heart block (LT)

Quinidex, Pronestyl an Norpace

Type: dysrhythmia drug


Class: I-A


Action: block Na+ channel, membrane stabilizing


Use: supraventricular/ventricular arrhythmias


Adverse: Pronestyl - can cause blood disorder/lupus like syndrome, Quinidex - can cause tinnitus


Caution: those with liver/kidney disorders


Nurse: many drug interactions, take on time schedule

Lidocaine

Type: dysrhythmia drug


Class: I-B (not used as much now)


Action: decrease automaticity in ventricles


Use: local anesthetic, serious dysrhythmias


Adverse: bradycardia, heart block, confusion


Caution: pregnant, elderly, acute MI


Nurse: IV in ICU only - monitor ptn very closely

Rythmol and Tambocor

Type: dysrhythmia drug


Class: I-C


Action: decrease conduction of ventricles


Use: given PO for ventricular arrhythmias


Adverse: sudden death, dizziness, fatigue


Caution: heart failure, liver dz, K+ imbalance


Nurse: monitor K+, given to ptn in hospital to see for adverse effects, black box warnings on both

Propranolol, esmolol and sotalol

Type: dysrhythmia drug


Class: II


Use: supraventricular tachycardia


Adverse: decreases cardiac output too much after a while


Nurse: must monitor ptn closely

Describe supraventricular tachycardia and which drugs are given for this?

Happens above the ventricle


-"narrow rhythm"



Class II drugs


Cordarone

Type: dysrhythmia drug


Class: III


Action: prolong action potential and refractory period in atria and ventricles, slow repolarization


Use: ventricular/problamatic dysrhthmias that can't be tx with other drugs


Caution: liver/pulmonary dz

Class III dysrhythmia drugs adverse effects and nurse implications

Adverse: pulmonary toxicity, vision probs, can deposit in fat, hypo/hyperthyroidism


-75% of ptns will experience adverse effect


Nurse: super long 1/2 life (2-3 months), monitor VS, thyroid function, drug interaction with Coumadin


-Black box warning due to lung/liver damage

Calan and Cardiazem

Type: dysrhythmia drug


Class: IV


Action: Ca+ channel blocker and slow inward flow of Ca+


Use: prevent/control supraventricular arrhythmias, HTN


Adverse: leg cramps, bradycardia, heart block


Caution: pregnant, heart block, hypotension, elderly


Nurse: monitor VS, give with food

Adenocard

Type: dysrhythmia drug


Action: slows conduction time through the AV node


Use: conversion of PSVT to sinus rhythm, after failure with other tx's


Nurse: given fast IV push in CC unit, asystole for a few seconds, then heart starts back up in reg rhythm

HTN diagnosis and what is first line treatment?

Diagnose: SBP>140 and/or DBP>80


Prehypertensive: SBP 120-139 or DBP 80-89



Treatment: Thiazide Diuretics <- especially for women


The 7 types of Antihyperstensives

1. ACE inhibitors


2. ARBS


3. Antiadrenergics


4. Beta adrenergic blockers


5. Ca+ channel blockers


6. Vasodilators


7. Diuretics

Lasix

Type: Anti-HTN Loop Diuretic - VERY POTENT


Class: diuretic


Action: increase water excretion by blocking reabsorption of Na+ and CL in loop of Henle


Use: pulmonary edema, edema, HTN, for rapid diuresis


Adverse: hypokalemia, dehydration, hypotension, ototoxic with high dose


Nurse: keep accurate I&O and weight, hold drug and contact MD if K+ level <3.5 in morn

General guidelines for diuretics

-Give in morning


-started singularly then other meds will likely be added

Aldactone

Type: Anti-HTN


Class: Diuretic (K+ sparing - pretty weak)


Action: causes Na+ loss in urine, inhibits aldosterone


Use: heart failure, HTN, edema, ascites


Adverse: hyperkalemia


Nurse: monitor K+, I&O, weight

Hydrodiuril

Type: Anti-HTN


Class: Diuretic (Thiazide)


Action: decrease reabsorption of Na+, water, CL and HCO3 in distal convoluted tubules


Use: given PO for HTN, heart failure


Adverse: electrolyte probs, dehydration


Contra: not for those with renal failure


Nurse: monitor VS's, photosensitive

Nifedipine, Norvasc and Cardizem

Type: Anti-HTN


Class: Ca+ channel blockers


Action: inhibit influx of Ca+ entering channels, produces vasodilation thus lowering BP


Use: Angina, HTN, Raynaud's


Adverse: hypotension, fusing, lower limb edema


Nurse: can't eat grapefruit due to synergitic effect, don't crush pill

What is Raynaud's and what medication should be used?

- Vascular disease usually seen in hands making them intolerant to cold



-Ca+ channel blockers

Nipride

Type: Anti-HTN


Class: Vasodilator


Action: direct vasodilation


Use: HTN emergencies - not first line tx


Adverse: tachycardia


Given: IV in ICU to produce controlled hypotension


Nurse: check HR/BP every 3-5 mins, cyanide poisoning possible with long term use

Apresoline

Type: Anti-HTN


Class: Vasodilator


Given: PO or IV


Nurse: less commonly used

The 3 class's of blood coagulation drugs

1. Anticoagulants


2. Antiplatlets


3. Thrombolytics



-Most dangerous drugs used today

Plavix and ASA

Type: blood coagulation durgs


Class: Antiplatelet


Action: decrease platelet aggregation


Use: prevent MI, CVA, Plavix used to improve graft potency (stent),


Adverse: bleeding


Nurse: monitor LOC

Anticoagulants (Action, Use, Adverse, Caution)

Action: interfere with coagulation cascade - can't break apart already formed clots but can help that they don't get larger


Use: thrombotic disorders, Angina, those with mechanical heart valves, atrial fibrillation, keep central lines from clotting, non-mobile patients usually going into surg


Adverse: HIT


Caution: those with bleeding disorders, gastric ulcers, pregnant

What is HIT and what drug can possibly cause it?

Heparin induced thrombocytopenia


-when someone has a catheter inserted into vein and clot forms.


-Heparin - not being used as much though b/c of this

Heparin

Type: blood coagulation drug


Class: Anticoagulant


Use: central line flushes


Given: IV infusion after DVT, IV push, SubQ


Nurse: given to patients who were previously on coumadin prior to surgery, give loading dose, very short half life

Protamine sulfate

Given in the case of an heparin OD

Levenox

Type: blood coagulation durg


Class: anticoagulant


Use: prophylactic to prevent clots


Given: SubQ ONLY, can be given at home, dosed by weight


Nurse: no lab work needed but VERY EXPENSIVE

Arixtra

Type: blood coagulation drug


Class: Anticoagulant


Use: prophylactic for DVT after hip fracture sugery, knee replacement, abd surgery


Given: SubQ

Coumadin

Type: blood coagulation drug


Class: anticoagulant


Action: interferes with Vit K dependent clotting


Given: PO, dosage adjusted daily


Nurse: 3-5 days for effect, many drug interactions, watch K intake (green leafy veggies), PT/INR should be between 2-3, Vit K antidote

Activase

Type: blood coagulation drug


Class: Thrombolytics (clot busters)


Action: dissolve clots, restore blood flow, prevent/limit tissue damage


Use: Acute MI, stroke, PE (not used as much in MI due to advances in PTCA's)


Adverse: bleeding Caution: pregnancy, delivery w/in 10 days


Nurse: give right after symptoms, check for bleeding every 15 mins/1st hour, 30 mins/next 4 hours, oral temp only, bed rest

What system do Adrenergic drugs mimic, what are the 3 receptors, and what are the 4 drugs?

Mimic: SNS "fight or flight"


1. Alpha - vasoconstrictor


2. Beta 1 - increase HR


3. Beta 2 - open up airway


- Epinephrine, Levophed, Dopamine, Neo-Synephrine

Adrenergic Agents (Action, use, adverse, nurse)

Action: mimic SNS - widespread action


Use: emergency CA, hypotension, bronchospasm, anaphylaxis, HF, bleeding


Adverse: arrhhthmias, HTN, palpatations, angina, nervousness


Nurse: can't be used with TCA and MAO anti-depressents, extreme care with calculations, monitor VS's, tolerance can develope

Epinephrine

Type: Adrenergic agent prototype

Levophed

Type: Adrenergic agent


Action: stimulates alpha receptors


Adverse: may see hands/feet turn purple


Dopamine

Type: Adrenergic agent


Action: stimulates alpha/beta


Nurse: dose determines effect


Low: increase urine


Med: increase cardiac output


High: increase BP


Neo-Synephrine

Type: Adrenergic agent


Action: stimulates alpha


Use: nasal decongestant