-
What does the cardiovascular system do?
- transports nutrients,
- wastes, gases, and hormones through the body
-
WHat does the urinary system do for the cardio system?
removes wastes from the circ. System to regulate pH and ion levels
Maintains H2O balance = regulation of Bp, fluids and electrolytes
-
WHat kind of action do cardiac drugs have on the urinary system?
direct/indirect action
-
When does heart failure occur
when the heart cannot pump enough blood to meet tissue needs for oxygen and nutrients
-
What is systolic dysfuncdtion
impaired myocardial contraction during systole
-
What is diastolic dysfunction?
impaired relaxation and filling of ventricles during diastole
-
what has HF been referred to as ?
Why?
- congestive heart failure (CHF)
- there is frequently congestion (fluid accumulation) in the lungs and peripheral tissues
-
What is the cause of heart failure at the cellular level?
dysfunction of contractile myocarial cells and the endothelial cells that line the heart and blood vessels
-
What does endothelial dysfunction do?
- allows processes that narrow the blood vessel lumen such as atherosclerotic plaque build up
- leading to blood clot formation and vasoconstriction which further narrows the blood vessel lumen
-
what are the most common conditions that lead to HF?
- Coronary artery disease
- hypertention
-
What are some causative factors of HF
- hyperthyroidism
- excessive IV fluids/blood transfusions
- drugs that decrease the force of mycocardial contractions
- drugs that cause sodium & water retention
-
what do HF causative factors do?
impairing maintanance of an adequate cardiac output by impairing the pumping ability or increaseing the workload of the heart
-
What are some feedback mechanisms that activate in HF
increased sympathetic activity & circulating catecholamine
activation of renin angiotension-aldosterone system
-
what do increased sympathetic activity & circulating catecholamines in HF do?
increase the force of myocardial contraction increase heart rate causes vasoconstriction
-
What is blunted in HF pts
What does this cause?
the baroreceptors in the aortic arch & carotid sinus that normally inhibit undue symapthetic stimulaiton
intensified effects of high catecholamine levels
-
What is Renin
An enzyme produced in the kidneys in response to impaired blood flow and tissue perfusion
-
What does renin do in the bloodstream
stimulates the production of a powerful vasoconstrictor - angiotensin II
-
What do arterial vasoconstriction do?
impairs cardiac function by increasing the resistance against which ventricle ejects blood (afterload)
-
What does increased afterload of the heart do
- raises filling pressures inside heart
- increases stretch & stress on myocardial walls
- redisposes to subendocardial ischemia
-
what do pts w/ severe HF have
constricted arterioles in cerebral myocardial, renal, hepatic & mesenteric vascular beds
increased organ hypofusion & dysfunction
-
WHat causes increased organ hypoperfusion & dysfunction?
constricted arterioles
-
What is preload?
- diastolic ventricular filling pressure
- amount of venous blood returning to the heart
-
What does angiotensin II do?
- stimulating aldosterone release from adrenal cortex &
- vasopressin (antidiuretic hormone) from posterior pituitary
these promotes sodium & water retention
-
What is afterload?
amount of resistance in the aorta peripheral blood vessels that the heart must overcome to pump effectively
-
What are the main S/S of HF
dyspnea & fatigue --> exercise intolerance & fluid retention--> pulmonary congestion & peripheral edema
-
WHat is compensated HF
asymptomatic
-
What kind of s/s occur in pt w/ compensated HF?
usually no s/s @ rest & no edema
dyspnea & fatigue usually only w/ moderate to higher level exertion activities
symptoms that do occur w/ min exertion or @ rest are accompanied by ankle edema & distention of jugular vein
-
what causes edema & jugular vein distention?
congestion of veins & leakage of fluid into tissues
-
what is S/S of acute, severe cardiac decompensation?
pulmonary edema (req immediate treatment)
-
What are HF drugs for
- to try to improve circulation
- alter compensatory mechanis
- reverse heart damage
-
what is the only commonly used digitalis glycoside?
Digoxin (lanoxin)
-
What are antidysrhythmic agents used for
prevention and treatment of cardiac dysrhythmia
-
when do dysrhythmias become a problem?
when they interfere with cardiac function & the ability to perfuse body tissues
-
What is automaticity of the heart?
the heart's ability to generate an electrical impulse
electrical impulse formation
-
what is exitability of the heart?
the ability of cardiac muscle cell to respond to electrical stimulus
-
What is conductivity?
ability of cardiac tissue to transmit electrical impulses
-
What is dysrhythmia?
any disturbance or abnormality in the normal cardiac rhythm
- feels as a skipped beat
-
when are dysrhythmias clinically significant?
when the interfere with cardiac function
-
What do antidysrhythmic drugs do?
alter the heart's electrical conduction system
-
How are antidysrhythmic drugs usually classified
- according to their mechanisms of action
- effects on conduction system
-
What is the goal of antidysrhythmic drug therapy?
- to prevent/relieve symptoms
- prolong survival
-
What do drugs for rapid dysrhythmia do
- reduce automaticity
- slow conduction of electrical impulses through heart
- prolong refactory period of myocardial cells
-
What are some Class I (Sodium Channel Blockers (membrane stablizers) antidysrhythmics?
- Norpace
- Procanamide
- Quinidine
- Lidocaine
-
What are Class I antidysrhythmic drugs?
Sodium Channel Blockers (membrane stablizers)
-
How do Class I antidysrhythmic drugs work?
interferes with the sodium channels and stabilizes the hearts excitability
-
What do Class I antidysrhytmics do?
- slow conduction velocity
- thus prolong refraction & decrease automaticity of
- sodium dependent tissue
- •Decreases the hearts excitability
- •Slows the inward current caused by Na electrolyte
- Decreases heart rate
- causing reduced irregular heartbeats
-
What does Quinidine do?
- reduces automaticity
- slows conduction
- prolongs refractory period
-
What does Quinidine do to electrical impulses?
accelerate their rate
-
What can Quinidine cause?
- loss of hearing,
- blurred vision,
- GI upset,
- tinitus,
- diarrhea,
- n/v
- vertigo
- thrombocytopenic pupura (TTP)
- decreased blood flow to the brain
-
What is thrombocytopenic pupura (TTP)
-blood disorder that causes blood clots to form in small blood vessels around the body, and leads to a low platelet count.
-
What do you need to check when taking Quinidine?
Why
Potassium levels before during and after use
- Increased potassium = increased effects of the medication
- And vice vers
-
Wher is Quinidine metablized and excreted?
- metab: liver
- excreted: urine
-
What are the theraputic levels of Quinidine?
2-5 mcg/mL
-
What are toxic serum levels of Quinidine?
> 5 mcg/mL
-
in what pts is quinidine contraindicated?
- severe, uncompensated HF
- w/ heart block
-
What is procainamide used for?
atrial and ventricular tachy-dysrhythmias
-
What is procainamide most effective for?
- suppressing premature Vent contractions
- preventing the recurrence of V tach
-
What can procainamide cause
high incidence of adverse effects
- lupus-like syndrome
- n/v/d- anorexia
- fever,
- leucopenia,
- maculopapular rash,
- itching/flushing
-
In what pts is procainamide contraindicated
- Lupus,
- complete heart block,
- 2nd and 3rd degree heart block
-
What are theraputic serum levels of procainamide?
4-8 mcg/mL
-
What is Disopyramide known as?
Norpace
-
What is Norpace used for?
adults w/ life-threatening ventricular tachydysrhthmias
-
What are the toxic serum levels of Norpace?
> 8mcg/mL
-
What are the theraputic levels of Norpace?
2-8 mcg/mL
-
Where is Norpace excreted?
kidneys & liver in almost equal proportion
-
-
What kind of side effects can norpace have?
- prodysrhthmiic
- anti-cholinergic
-
in what pts is norpace contraindicated?
with poor left vent function
-
How does the incidence of lupus w/ norpace compare to procanamide
less than that of Procanamide
-
What are class II antidysrhythmic drugs?
beta blockers
-
What kind of beta blockers are there?
- selective (1)
- nonselective (1&2)
-
How do Class II antidysrhythmics work?
- slowingm the sympathetic nervous system stimulation of beta receptors
- slow SA & AV nodal conduction
- block receptors in SA node & ectopic pacemker
-
What kind of dysrhythmia are ClassII effective against?
dysrhythmia from excessive sympathetic activit
-
What are Class II (Beta blockers) antidysrhythmics most often used for?
to slow the ventricular rate of contraction in atrial flutter & a-fib
-
What do Beta Blockers do?
- Blocks (or slows) the SNS stimulation to the heart-REDUCES THE HEART RATE and force contraction
- help slow heart down
- decrease force
-
When are Beta Blockers especailly beneficial ?
Why?
after an MI
because many catecholamines are released at that time and can make the heart hyperirritable
-
What is the reduction rate of cardiac death after an MI for pt on Class II antidysrhythmics?
25%
-
What cells do Class II block?
Beta 1, 2 & 3 adrenergic receptors
-
What system are Beta adrenergic receptors part of ?
- part of the SNS (fight or flight)
-
Where are β 1-adrenergic receptors mainly located?
in the heart and in the kidneys
-
Where are β 2-adrenergic receptors mainly located?
- in the lungs,
- gastrointestinal tract,
- liver,
- uterus,
- vascular smooth muscle,
- skeletal muscles
-
Where are β 3-adrenergic receptors located
in fat cells
-
What do most Beta Blockers (class II) drugs end in?
-
What is usually the 1st sign of impending hypotension?
What are other signs
Dizziness
- pulse: <60
- Systolic BP <90mmHg
-
What do you do if pt is experiencing hypotension on Beta blockers?
withhold the beta blocker and contact a Dr.
-
What are some Beta Blocker (Class II antidysrhythmic) drugs?
- Propranalol
- Tenormin (Atenolol)
- Breviblock (Esmolol)
- Lopressor (Metoprolol)
- Inderal (Propranolol)
- Betapace (Sotalol)
-
What is propanalol commonly used for?
for acute sinus tachy
-
What do you need to do for propanalol?
why?
assess closely for Bradycardia
it will cause a decrease in heart rate which can = Bradycardia
-
What can propanalol cause?
- Bradycardia
- rash and itch
- Erratic blood sugars up and down
- Chest pain
- Joint pain
-
What is another name for propranolol?
inderal
-
What do you need to report when taking propanalol?
-
WHat does Tenormin (Atenolol) block?
beta-1’s on the heart
-
What is another name for Tenormin?
Atenolol
-
What is Tenormin used for?
angina and hypertension
-
for what pts is Tenormin contraindicated for?
with severe bradycardia, CHF and cardiogenic shock
-
What is Breviblock?
shorter acting beta-blocker
-
What does Breviblock block?
Beta 1
-
What is Breviblock used for?
SVT (supraventricular tachycardia)
dysrythmias that originate above the ventricals and are fast
-
What can breviblock be used for?
- tachyarrythmias that occur after an acute MI
- to control hypertension
-
What beta blocker has a rapid onset & short duration of action
breviblock
-
When is Breviblock often given?
- during anesthesia
- surgery
- other emergency situations when vent rate must be rapidly reduced
-
What is another name for Breviblock?
Esmolol
-
What kind of therapy is Breviblock not used for?
chronic
-
In what pts is breviblock contraindicated?
- with asthma
- for those with 2nd or 3rd degree heart block or CHF
-
What does Breviblock tend to exacterbate?
asthma
-
What is another name for Lopressor ?
Metoprolol
-
When is lopressor commonly given?
given after an MI to reduce risk of cardiac death
-
What are some conditions lopressor is used for?
- hypertension,
- angina,
- acute myocardial infarction,
- supraventricular tachycardia,
- ventricular tachycardia,
- congestive heart failure
- prevention of migraine headaches
-
What can lopressor used for?
treatment of hypertension and angina
-
WHat does LOPRESSOR HCT contain?
a hydrochlorathiazide diuretic
-
What is lopressor HCT used for? ?
To diurese the patient, thus decreasing Bp
-
What kind of Beta blocker is lopressor?
Selective- beta 1’s
-
What are some s/e of lopressor (metaprolol) ?
- hypotension,
- dizziness,
- blurred vision
- etc
-
What can be an issue w/ lopressor (metaprolol) @ 1st?
Safety will be an issue at first
-
What do you need to assess with lopressor?
- electrolytes
- bp
- I&O
- daily wt
-
What do you need to do right before giving Bp Meds?
Bp
-
WHat kind of betablocker is Inderal (propranolol)?
is nonspecific (beta 1 and 2- works on receptors in the heart and lungs!)
-
What does Inderal (propranolol) reduce?
- HR
- myocardial contractility
-
What is the oldest beta blocker?
Inderal (propranolol)
-
What is Inderal (propranolol) used for?
- hypertension,
- angina
- VTach,
- supervent dysrhythmias,
- pheocromocytoma*
- Used post MI, and for migraines
-
What is pheocromocytoma?
Adrenal gland tissue tumor
rarely canerous
-
What causes pheocromocytoma?
the release of too much epinephrine and norepinephrine- controling heart rate, metabolism, and blood pressure
-
What problems does does pheocromocytoma usually cause
problems in controlling HR< metab, BP
-
in what life stage group is pheocromocytoma common in?
early middle-adulthood
-
what can pheocromocytoma cause?
- tachy,
- weight loss,
- irritability
- palpitations
-
What is Betapace used for?
treatment of DOCUMENTED life-threatening vent dysrythmias such as sustained V tach
-
What is another name for betapace?
Sotalol
-
What can betapace cause?
new dysrhythmias
-
in what pt is betapace contraindicated for?
- bronchial asthma ,
- sinus brady or cardiogenic shock
-
What are class III antidysrhythmics most commonly used for?
to treat dysrhythmias that are difficult to treat
-
What are class III antidysrhythmics?
Potassium Channel blockers
-
What are Class III antidysrhythmics used for?
the conversion of A-fib and flutter to a NSR(normal sinus rhythem)
-
What are most Class III antidyrhytmics used for?
difficult to treat dysrhthmia
-
What antidysrhythmic class is still somewhat investigational?
Class III
-
What is another name for Amiodarone
pacerone
-
what is Amiodarone used for?
life-threatening vtack or V-fib that is resistant to other drugs (Drug of last resort!)
also for the treatment of sustained V-tack
-
What kind of drug are Class III antidysrhtymics?
-
What has Amiodarone been shown to effect?
atrial dysrhythmias that are resistant
-
What is bad with Amiodarone?
Has a lot of unwanted s/e-
-
what does Amiodarone contain?
IODINE in it’s structure (watch for allergies)
-
What can Amiodarone cause?
therefore can cause hyper or hypo- thyroidism
-
What do you need to assess before giving Amiodarone?
thyroid function
-
with Amiodarone at what dosage do you see more likely to see unwanted s/e's
Doses exceeding 400mg/D
-
What are the most common s/s of Amiodarone?
corneal microdeposits- causes halo’s, dry eyes & photophobia
-
in what amiodarone pt's do corneal microdeposits occur
Occurs in almost all adults on the med for 6 months or more
-
What effects do amiodarone have?
vasodilating effect
-
What does amiodarone do?
decrease systemic vascular resistance prolongs conduction in all cardiac tissue decreases heart rate
-
What are some unwanted s/e to amiodarone ?
- serious/potentially fatal pulmonary toxicity
- may begin w/ progressive dyspnea
- cough w/ crackles
- dercreased breath sounds
- pleurisy
- heart failure
- hepatotoxicity
-
What is the most severe s/e of amiodarone?
pulmonary toxicity
-
What is an important property of amiodarone?
it is lipophilic- loves to migrate to adipose tissue
-
in what forms is Bretylium available in?
Only available IV
-
What is Bretlium used for?
to treat life-threatening V-tach or fib
-
What is Bretylium primarily used for?
Used primarily in a code situation
-
What does Bretylium cause?
postural hypotension in 50% of patients
-
What does Bretylium do?
Slows conduction of ventricular portion of muscle
-
What is Bretylium?
adrenergic blocking (slows release of norepi)
-
What can Bretylium cause
n/v
-
How is Bretylium given?
Given slow IV to reduce s/e
-
Wher is Bretylium usually given?
usually only in ICU/ambulance
-
What is Covert indicated for?
recent onset of ATRIAL dysrhythmias (A-fib and flutter)
Electrocardioversion
-
What is the only drug therapy available for rapid conversion into NSR fro a-fib/flutter?
Covert
-
How should Covert be given?
in a setting w/ ER personal & equipment close by
4 hours apart from other antidysrhythmics
very cautiously
-
in what form should Covert be adminisstered?
Only IV and specifically weight based
-
What are Class IV antidysrhythmics?
(Calcium channel blockers)
-
what are Calcium channel blockers (class IV) used for?
for the treatment of hypertension and angina
-
What do Calcium channel blockers do?
Slows or blocks the calcium channels of the cell into the myocardium
-
What are the Class IV antidysrhythmic drugs?
-
What is another name for Cardizem?
Diltiazem
-
What is another name for Verapmil?
Calan
-
What is Cardizem not used for?
- MI,
- pulmonary congestion,
- severe hypotension,
- cardiogenic shock,
- sick-sinus syndrome,
- 2nd/3rd degree heart block
-
What is Cardizem used for?
-
What is Verapmil (Calan) used for?
- to prevent and convert recurrent PSVT( paroxysmal SVT) to control vent response in a-fib or flutter
- Angina
-
In what pt's are cardizem & Verpmil contraindicated for?
Why?
digoxin toxicity
may worsen heart block
-
What does Verapmil precipitate with?
•Precipitates with Nafcillin and Sodium Bicarb
-
what drug should not be put into the same IV asVerapmil?
beta blockers
-
What are Nitratesoften taken with
often taken WITH Calcium Channel Blockers
-
Why do you need to be careful when giving Antidysrhythmics to elderly?
increased side effects- weakness and dizziness (safety)
-
What can nicotine do to Antidysrhythmics?
decrease effectiveness
-
What effects can ETOH have on antidysrhythmic drugs?
increase hypotensive episodes
-
What happens if you abruptly stop taking antidysrhythmic?
can have a rebound effect
-
What do you assess for when giving antidysrhythmic ?
- •Not used in: Hypersensitivity
- CHF- can worsen effects of CHF
- Complete heart block*
- Hypotension
- MG
- Urinary retention
- Hepatic/renal insufficiency
- EKG/TELEMETRY
-
What is Heart Block?
A heart block can be a blockage at any level of the electrical conduction system of the heart
-
WHat drugs interact with antidysrhythmics?
- •NMBA’s
- Anticholinergic’s- causes increased anti-cholinergic effects
- Anticoags- with quinidine
- Dig. and quinidine- increases serum dig levels
- Cimetadine/Nefedipine
- Anticonvulsants
-
What should be done when giving antidysrhythmics?
- Initial EKG and VS
- monitor these closely throughout course
-
What should be done with IV antidysrhythmics?
have on pump
-
What kind of monitored should pt's on IV antidysrhythmics be on?
continous cardiac monitor
-
What are some adverse reactions you should watch for w/ pt's on antidysrhythmic drugs?
- heart block
- dysrhythmias
- hypotensioin
-
What reactions should be reported b pt's taking antidysrhytmics?
- Any increased cough,
- SOB,
- weight gain
-
How is Lidocaine administered
IV
-
How does Lidocaine work?
It increase the electricalimpulses and weak impulses are weeded out
-
What does lidocaine do?
it slows the heart rate overall
-
What do you asses for when giving lidocaine?
- tinitus,
- blurred vision,
- HA/dizziness,
- seizures,
- hallucinations
-
What kind of antidysrhythmic drug is Adenosine?
unclassified
-
What is Adenosine given for?
cardioversion
-
Whatdoes adenosine cause?
several seconds of asyystole when cardioverting tach to NSR
anxiety
-
What is cardioverting?
converting abnormally fast heart rate or cardiac arrhythmia to a normal rhythm
-
how should Adenosine be given?
by rapid bolus injection
needed?
-
What should you do when giving Adenosine?
-
What is Angina?
The ACHING of the heart muscle due to insufficient oxygen in the blood
-
in angina usually idiopathic?
yes
-
What are the differant types of angina?
- Chronic Stable Angina
- Unstable Angina (USA)
- Vasospastic Angina
-
What is Chronic Stable Angina caused by?
atherosclerosis
-
What can trigger Chronic Stable Angina?
exertion or stress (cold, fear, emotions)
-
What can exacerbate Chronic Stable Angina?
Smoking, drugs, etoh, caffeine, coffee
-
What are some s/s of Chronic Stable Angina?
Intense pain that subsides in about 15 minutes
-
What is Unstable Angina an early stage of?
early stage of progressive CAD
-
what can Unstable Angina progress to over the years
May end in MI in sunsequent years
-
What are s/s of Unstable Angina?
Pain increases in severity with each attack and attacks become more frequent
-
When can Unstable Angina occur?
Can happen at rest when condition progresses
-
What is Vasospastic Angina?
spasms of the smooth muscle layers that surround the atherosclerotic coronary arteries
-
When does Vasospastic Angina usually occur?
at rest
-
WHat is an aspect of -asospastic Angina?
Seems to follow a regular pattern- occurring around the same time of day
-
WHat drugs are used to treat Angina?
- NITRATES/NITRITES
- BETA-BLOCKERS
- CALCIUM CHANNEL BLOCKERS
-
What drugs are most effective for CAD?
NITRATES/NITRITES
-
What do NITRATES/NITRITES act on?
Act on vascular smooth muscle- relaxes arterial and venous circulation
-
What are Nitrates/Nitrites
NITROGLYCERIN: (Rapid acting)
-
What pt's are Nitrates/Nitrites contraindicated for?
- with ICP,
- inadequate cerebral perfusion,
- pericarditis,
- pericardial tamponade (fluid accumulation in the heart causing increased pressure),
- severe hypotension,
- severe anemia
-
Where are oral Nitrates/Nitrites metabolized?
metabolized in the liver- a lot is removed from circulation (LARGE first-pass effect)
-
How are Nitrates/Nitrites usually given?
- given SL or Buccal so bypasses the first pass effect
- Can be administered transdermally
-
for what conditions are Nitrates/Nitrites given IV?
- acute MI,
- CHF,
- Pulmonary edema
-
What does giving Nitrates/Nitrites topically do?
bypasses first pass effect- allows for slow delivery of the drug
-
How do you administer Nitrates/Nitrites transdermal patchs?
usually OFF for 8 hours at night, new patch in the AM (review)
-
What do Nitrates/Nitrites do?
•Dilates all blood vessels, but mainly effect those in the venous circulation
-
What do Nitrates/Nitrites do in small doses?
Slight arterial dilation in low doses
-
What are some s/e of Nitrates/Nitrites?
- HA is most common- can be very severe
- Tachycardia
- Postural Hypotension
-
What should you do if pt gets postural hypotension from Nitrates/Nitrites?
- assess laying, sitting and standing
- educate safety
-
What causes cause increased anti-hypertensive effects with Nitrates/Nitrites?
- ETOH,
- phenothiazines,
- CCB’s
safety is an issue
-
WHat is the 1/2 life of Nitrates/Nitrites?
1-4 minutes- readily absorbed
-
WHat are s/s of postural hypotension?
- flushing,
- dizziness,
- sweating,
- syncope
-
in what pt's is the safety of taking Nitrates/Nitrites still being investigated?
with acute MI
-
in what pt's is Nitrates/Nitrites transdermal patch showing good performance?
recent MI
-
How often do you need to renew Nitro Rx?
every 3 mo-loses strength
-
What does Nitro cause?
a throbbing headache- it is a potent medication
-
What can you take for HA cause by Nitro?
analgesic
-
What substinces when taken w/ Nitrates/Nitrites cause severe hypotension?
- ETOH
- beta blockers,
- narcotics,
- antihypertensives,
- vasodilators
-
How should you take po nitro
on an empty stomach
-
What does Tobacco use do to nitrates?
reduces effects
-
What does Nitroglycerin do to VMA lab levels?
increases VMA (vanillylmandelic acid) levels (end stage metabolite of epi and norepi)
-
What is SL Nitroglycerin used for?
for CP- ASAP
-
What do you need to educate pt to do w/ SL Nitroglycerin?
•Educate to keep on their person at all times
-
What should SL Nitroglycerin pt's do if they feel CP?
lay down w/ feet up take dose
-
What does a SL Nitroglycerin pt do if they inf they don't get relief from CP after 2 doses?
-
how long should SL Nitroglycerin pt's wait b/w doses if having CP
3-5 min
-
How should nitroglycerine be stored?
- dark glass
- it is light sensitive
- sunlight and light can decrease the effects of medication
- •No cotton in the bottle- decreases effectiveness
-
What is needed when giving IV Nitro?
ICU monitoring
-
WHat should you report when taking Nitro?
-
WHy should you watch for nitrate abuse?
can cause sexual stimulation
-
are ISOSORBIDE DINITRATE & ISOSORBIDE MONONITRATE fast or slow acting antianginic drugs
fast acting
-
What is another name for Isosorbide Dinitrate
Isordil
-
Where is Isordil metabolized ?
in the liver
-
What is Isordil used for?
Used for acute angina and for the prophylaxis of
-
in what forms is Isordil available?
PO only
-
What is another name for Iso Mononitrate?
Imdur, Ismo, Monoket
-
What is Iso Mononitrate used for?
•Provides a more steady, therapeutic response than Isordil
-
How are Ismo and Monoket given?
2X daily with 7 hours in between doses so as not to build a nitrate tolerance*
-
What do Beta blockers do for Angina?
- slows she heart rate and decreases contractility
- Slows the contractility- decreasing energy needs
-
WHat are beta blockers used as in Angina?
1st line drug for stable angina and “effort induced angina”*
-
What is effert induced angina?
angina w/ excersion
-
How do beta blockers effect O2 demand?
•Decreases O2 demand, therefore increases O2 availability to the myocardium
-
how can Beta Blockers effect DM pt's
can increase Blood glucose
-
What are some common s/e of Beta Blockers r/t hypotension
-
What are some s/e of Beta Blockers used for angina?
- Hypotension- due to vasodilation- assess pulses can decrease peripheral blood flow
- Can cause bradycardia
- Dizziness,
- fatigue,
- lethargy
- Can cause impotence
- wheezing
- dyspnea
-
Wha pt's should beta blockers and other vasodialaters not be used for?
-
WHat are some Beta Blockers used for Angina?
ATENALOL (Tenormin)
LOPRESSOR (Metoprolol
-
What is Atenalol used for?
often used after an MI to decrease death rate
-
What is IV Atenalol good for?
Good immediately after an MI because blood flow to GI tract is poor and most are intubated
-
What forms do Atenalol & Lopressor come in?
-
What is Lopressor used for?
LOPRESSOR (Metoprolol)
-
What are Calcium Channel Blockers used do to treat Angina
•Decreases myocardial O2 demand by causing peripheral arterial vasodilation, reduces myocardial contractility (decreases pain) decreases Bp
-
What are pt's taking CCB's at high risk for?
peripheral edema
-
Why are CCB's used as a 1st line drug for angina?
Safe with few contraindications
-
What are some CCB's for angina?
- CARDIZEM, TIAZAC
- NIFEDIPINE (Adalat/Procardia)
- VERAPAMIL (Calan)
-
What is CARDIZEM, TIAZAC used for?
effective oral treatment of angina
-
in what form is CARDIZEM, TIAZAC available in?
-
What did we once have to do NIFEDIPINE (Adalat/Procardia) ?
puncture the liquid filled capsule and squeeze under the tongue
-
Why do we no longer squeeze NIFEDIPINE (Adalat/Procardia) under the tongue
they have decided that this increases the mortality rate
-
What are some side effects of CCB?
- Hypotension
- Brady
- heart failure
- Constipation-esp in elderly
- nausea
- Rash
- Peripheral edema-esp pitting edema in extremeties
- Wheezing
-
What do you watch for w/ CCB?
I&O-hypotension
-
WHat are CCB's not used with?
- Beta blocker-additive effect -both lower BpDigoxin- can increase dig levels
- H2 blockers- increases CCB levelsTheophyline
- Lithium
- ETOH
- Trycyclic antidepressants
- Tobacco
-
What can peripheralvasodilator medications be used for?
occlusive arterial disease (limited success)
-
What do peripheralvasodilator medications do?
Relaxes smooth muscle of peripheral arterial vessels increasing circulation to the extremities
-
WHat do you see w/ pt's taking peripheralvasodilator medications?
-
increaed edema
- swelling to the lower legs and feet
- often ulcerations below the knees
-
WHat disease can peripheralvasodilator medications be used to treat?
treat Raynaud’s disease (vasospasms and thrombophlebitis)
-
What happens in Raynaud’s disease ?
no circ to extremeties
-
When can vasodialater s/e subside
usually after a few weeks
-
What kind of medication is Viagra
vasodialators
-
What do vasodialators cause?
- hypotension,
- dizziness,
- post. Hypotension,
- HA,
- dysrythmias,
- sweating,
- tingling,
- but disappear after a few weeks of txt.
-
What do some vasodialators have in them?
“tartrazine”
-
WHat can tartrazine cause?
allergic reaction with s/s like bronchial asthma
-
WHat can cause an increased risk to allergies to tartrazine?
allergies to ASA
-
in what pt can meds containing tartrazine be contraindicated?
- those w/ COPD,
- Asthma
- other brancoconstriction
-
WHat do you asses for cardiac meds?
- •Assess and list all other drugs
- any allergies
- Medical and surgical Hx
- Caution with head injuries
- pregnant/lactating women
- VS, EKG, RESP status
- Not used with liver/kidney disease if possible
-
how do you administer IV Nitro?
- in a glass bottle only*
- •Covered in aluminum foil or in a dark bottle and dark tubing
- NO filters
-
How long is IV nitro stable?
96 hrs
-
how should all cardiac meds be administered?
always on a pump
•Not mixed IV with any other drugs
-
WHat should pt's be educated to do for all cardiac drugs
- Decrease caffeine containing foods/drinks,
- cardiac diet
- decrease sodium
-
How should pt's get off of cardiac meds?
tshould be tapered off
-
WHen should be checked w/ cardiac meds?
- Bp before giving meds
- check electrolytes
-
What happens to blood vessels secondary for Hypertension?
Blood vessels decrease in elasticity
-
what happens to the heart w/ hypertension
has to work much harder-This causes stress on the heart muscle and vessels, veins and arteries
-
WHat needs to happen for the HTN treatment to be most effective?
needs to be identified and treated early in the game
-
What is normal BP?
<130 S / <85 D
-
What is the BP for stage 1 HTN?
140-159/ 90-99
-
What is the Bp for stage 2 HTN?
160-179/ 100-109
-
What is the Bp for stage 3 HTN?
180-209/110-119
-
What is the Bp for stage 4 HTN?
> or = to 210/> or = to 120
-
What is the goal of HTN drugs
Why?
- Diastolic below 90
- decrease damage risks to kidneys,
- heart
- brain
-
WHat are the differant kinds of antihypertensives?
- Adrenergics
- Alpha 1 -adrenergic blockers
- Minipress
- Regitine
- Alpha 2- adrenergic receptor stimulators
-
What are antihypertensive drugs?
- Clonidine- (Catapres)
- Methyldopa
- ACE Inhibitors
- Lisinopril (Zestril, Prinivil)
- Captopril (Capoten)
- Vasotec
- Angiotensin II Receptor Blockers
-
What are Adrenergic receptors the target of?
catacholamines like epi and norepi
-
What are some of the Adrenergic receptors subtypes?
Alph 1&2,Beta 1&2
-
What do Adrenergics do?
- They inhibit or block stimulation of epi/norepi
- Decreases BP and heart rate
-
WHat can adrenergics cause?
postural and post-exercise hypotension
-
What can adrenergics be used for?
- to treat Migraines
- Can be used for severe dysmennhorea and menopausal
- flushing
-
What are some s/e of adrenergics?
-
Dry mouth
- Constipation
- drowsiness, constipation
- HA
- Nausea
- Rash
- Ortho hypotension
-
What are some interactons w/ adrenergics?
- CNS depressants- ETOH, barbituarates, opioids
- Epi and beta-blockers can increase effect, decreasing BP too much!
-
What are Alpha 1 -adrenergic blockers?
-
What do -Alpha 1 -adrenergic blockers do?
•Block alpha 1 receptors in the arteriesOnly
-
In what forms are Alpha 1 -adrenergic blockers availables?
PO only
-
WHat are some Alpha1 adrenergic blokers for?
-
What does Minipress do?
- Dilates arterial and venous blood vessels
- This decreases blood pressure
-
WHat can Minipress relieve?
urinary symptoms with BPH
-
What can Minipress be used w/?
cardiac glycocides and diuretics fro CHF
-
What can Minipress cause?
- severe orthohypotension,
- but most will develop a tolerance after the first dose
-
Wha is Regitine used to treat?
estravasated epi, norepi and dopamine infusion sites
-
What is Regitine used to Dx?
pheocromocytoma
-
How is Regitine used to Dx pheocromocytoma?
If pheocromocytoma is suspected: pt has HTN and an IV dose of Regitine is given- this will cause a decrease in Bp and diagnosis can be made
-
When are Alpha 2- adrenergic receptor stimulators used
•This class will be used if all other classes fail
-
WHat s/e is there a high incidence of w/ Alpha 2- adrenergic receptor stimulators
- HIGH incidence of severe orthostatic hypotension,
- fatigue
- dizziness
-
WHat are some Alpha 2- adrenergic receptor stimulators drugs
Clonidine- (Catapres
Methyldopa-
-
What does Clonidine- (Catapres) do?
decreases Bp and can also be used for opioid
-
What pt's is Clonidine used for?
used for severe pain in cancer patients
-
WHat group is Methyldopa drug of choice for?
pregnent woman
-
WHy should Beta blockers not be used on pregnant women?
Beta blockers decrease the SNS stimulation in the heart and decrease heart rate and Bp more so than this drug- so think fetus effects
-
What kind of enzyme is ACE
Angiotensin-Converting Enzymes
-
What does ACE inhibiters do?
mediate extracellular volume and arterial vasoconstriction component of the Bp regulating system
•They prevent Na+ and H2O reabsorption
-
What do ACE inhibiters cause?
diuresis
-
What is the largest group of antihypertensives
ACE inhibiters
-
What are ACE inhibiters used as?
•Safe first line agent to treat CHF and hypertension
-
what does the prevention of sodium and H2o reabsorption in ACE inhibiters cause?
decrease in the blood volume and return to the heart which decrease the Bp.
-
What is there a risk of with ACE inhibitors?
Hyperkalemia
-
What do you need to do when giving ACE inhibitors?
•Monitor k+ levels, and educate about K+ in the diet!
-
What are some side effects of ACE inhibitors?
- •Fatigue,
- HA,
- mood changes,
- dizziness
- Dry non-productive cough* that reverses if med stopped
- Loss of taste
- Anemia
- Proteinuria
- Rash and itching
- Hyperkalemia
-
What disease are ACE inhibitors not used in
renal disease
-
What are S/S of ACE inhibitor OD?
Severe hypotension
-
How do you treat ACE inhibitor OD?
Give IVF’s to expand the volume and blood volume
-
What may be required if pt OD of captopril and lisinopril
HD
-
What can you not give w. ace inhitibitrs
•Do not give with ASA, NSAIDS, K+ sparing diuretics or K+ supplements
No lithium b/c it increases lithium levels
-
What is Captopril (Capoten) Commonly used for
-
What are some s/e of ace inhibitors?
•Fatigue, HA, mood changes, dizziness•Dry non-productive cough* that reverses if med stopped•Loss of taste•Anemia•Proteinuria •Rash and itching•Hyperkalemia Not used in renal disease- can cause acute failure
-
for what pt's is Captopril (Capoten)
•patients in fragile state
-
What form does Captopril (Capoten ) come in?
•Only available PO
-
What kind of diet is recommened for pt taking Lisinopril (Zestril, Prinivil)
Low Na+ and low K+ diet suggested
-
What are other names for Lisinopril ?
-
What is Lisinopril (Zestril, Prinivil) used for?
- •Lisinopril is used to improve survival after a heart attack
- Used to treat CHF
-
For what group is Lisinopril (Zestril, Prinivil) not used?
•NOT used in pregnancy
-
How is Lisinopril (Zestril, Prinivil) used
used alone or in combination for hypertension
-
Vasotec
•Oral an IV preps
-
Vasotec
•To be converted into an “active metabolite”- must have proper liver function
-
What does Vasotec do?
•Improves survival rates of those post MI
-
Angiotensin II Receptor Blockers
-The blockers relax the blood vessels to decrease Bp by decreasing the narrowing effect
-
Angiotensin II Receptor Blockers
•These are fairly well tolerated and do not cause the cough!•Improves survival rates s/p MI•Used to treat CHF•Can be used cautiously with DM, and renal dysfunction in those that have shown a tolerance for the medication without side effects**•Can cause birth defects- not a great idea with pregnancy
-
side effects of Angiotensin II Receptor Blockers
•URI symptoms•Nasal congestion•Dizziness•Dyspnea •Diarrhea, heart burn•Back pain•HA and fatigue•OD/Toxicity- expand circulatory volume and support systems•Hyperkalemia
-
Angiotensin II Receptor Blockers interactions
•Lithium- increases levels•Cimetadine, Rifampin, and Phenobarbitol reduce the effectiveness of Cozaar •Diflucan decreases the conversion of Cozaar into its active form•Report any side effects to physician
-
side effects of Angiotensin II Receptor Blockers
•Cozaar/Hyzaar (Cozaar with HCT)- used for txt. Of hypertension and CHF•May have slightler lower mortality rates than seen with ACE inhibitors in CHF•No breast feeding- crosses into the milk•Diovan (Diovan HCT (with diuretic)Can be used along with other anytihypertens
-
Angiotensin II Receptor Blockers
-
Angiotensin II Receptor Blockers The drugs:
Cozaar/Hyzaar
Diovan
-
What is Cozaar/Hyzaar (Cozaar with HCT) used for
used for txt. Of hypertension and CHF•
-
How does Cozaar compair with ACE inhibitors in CHF?
May have slightler lower mortality rates than seen with ACE inhibitors in CHF
-
in what groups is Cozaar contraindicated?
Why?
breast feeding women
crosses into the milk•
-
What can Diovan be used with?
Can be used along with other anytihypertens
-
What do many antihypertensives come with
•Many as you see- come with a diuretic in on preparation
-
What do diureticsin antihypertensives do?
•These decrease extracellular fluid volumes so there is a decrease in preload which decreases the effort of the heart
-
What do vasodilating antihypertensives do?
relax the smooth muscle of the heart and long-term constriction will cause major damage to heart, brain and kidneys!
-
What do PO Minoxidil & Rogaine do?
decreases Bp
-
What do topical Minoxidil & Rogaine used for
- used for hair growth,
- but can it cause hypotension
- educate
-
What do you need to assess for antihypertensives?
- •Assess liver and kidney function
- Assess stress
- Any PVD?
- Any history or suspect of pheocromocytoma?
-
In what groups do you need to use antihypertensives cautiously?
Use all cautiously with kiddos and elderly- they are more sensitive and the diuretics can cause an increased lyte imbalance
-
What should you watch in pt's w/ antihypertensives?
•Watch K+
-
What can you drink with antihypertensives?
Can take some meds with OJ unless contraindicated
-
How does taking antihypertensives affect one's diet?
- they should eat K+ rich foods unless contraindicated
- Avoid increased Na+ intake
- Garlic can be taken to decrease Bp, but not with coumadin, NSAIDS, anti-platelets or ASA!
-
What assessments do you need to do for antihypertensives?
- Baseline VS and weight and then along the way
- QD weights
- I/O
- Baseline EKG, telemetry
-
WHat S/S do you need to check for with antihypertensives?
- •Watch for syncope
- Swelling in the feet, ankles, eyes
- Assess CP and palpitations
-
What lifestyle changes should pt's on antihypertensives do?
- Loose weight,
- avoid stress,
- exersize safely
- Watch sodium intake
-
What can hypokalemia cause?
•Leg cramps?
-
What must pt's on antihypertensives be wary of?
the OTC’s•
-
What should pt's on antihypertensives do?
- Change positions slowly
- Stay hydrated
- Oral formulas with meals to decrease GI upset
-
What should pt's on antihypertensives avoid
smoking or ETOH
-
What is Hemaetopoesis?
the process of blood cell formation (RBC's/WBC's & Plateltets)
-
What is iron used for?
tissue respiration
-
What is Iron?
a O2 carrier in Hgb & myoglobin
-
What is Iron used in?
many enzyme reations in the body
-
Where is iron stored
- liver,
- spleen
- bone marrow
-
What does Iron deficiency cause?
anemia
-
Who requires the most iron?
women
-
What is iron found in?
found in meat certain veggies grains
-
How is iron metabolized?
must be converted by gastric juices before they can be absorbed
-
What foods help w/ absorption of iron?
-
What foods may impair absorption of iron?
-
What can Iron supplements cause?
- Nausea
- stomach upset
- vomiting
- diarrhea
- abd cramping
- constipation
- black or red tarry stools
- can discolor tooth enamel & eyes
- causes pain upon injection
-
What is most common in OD death in pedi?
Why?
- iron toxicity
- enteric coated & resemble candy
-
What is treatment of iron OD?
- symptomatic treatment & supportive measures
- MAINTAIN the airway
- correct acidosis
- control shock & dehydration w/ IVF's or blood
- O & vasopressors
- Iron preparations are radiopaque & may be seen in x-ray
-
At what is iron serum concertration are pt's at serious risk of toxicity?
300 >ug/dl
-
What should be done to the stomach for iron OD?
- stomach should be emptied via ipecac syrup or lavage
- whole gut lavage
-
What does severe toxicity cause?
What should be done?
coma/shock/seizure
chelation therapy w/ deferoxamine should be initiated(ring shaped molecules that bind to metal)
-
When is iron absorption enhanced?
when given w/ absorbic acid
-
When is iron absorption reduced
when taking antacids
-
What meds does iron reduce the effects of?
- thyroid
- tetracycline
- quinolones (antibiotics)
-
What are some iron supplements?
- ferrous fumarate (feostat, Hemocyte)
- Iron Dextran (INFeD)
-
What are Ferrous Furnarates
iron salts
-
What do Ferrous Furmarate contain?
the highest amount of iron per gram of salt consumed
-
What is Iron Dextran?
Colloid solution of iron and dextran
-
What is Iron Dextran used for?
iron deficiency Anemia
-
How is Iron Dextran administered?
IM & IV
-
What does Iron Dextran have a low incidence of ?
anaphylaxis
-
How is Iron Dextran administered?
- 1st give test dose (25mg)
- if there is an anaphylactic reaction it will be within a few minutes after test dose given
-
What is folic acid?
water soluble B compelx vit
-
What does Folic acid help prevent in pregnency?
- neural tube defects
- such as spina bifida, encephaly & enecphalocele
-
When is it best to take folic acid for earliest ability in pregnancy?
at least one month before pregnanay
-
What is Folic Acid the primary treatment for?
megaloblastic anemia-resulting from folic acid deficiency
-
what kind of intake of folic acid does the body require?
oral
-
WHat are some foods with folic acid
- dried beans,
- peas,
- oranges
- green veggies
-
What is Questran
a bile acid blocker
-
what are s/e of zetia
- diarrhea, back pain, and abdominal pain.
- works spec on GI tract
-
What is the main goal of dyslipidemic therapy
LDL <100
raise HDL lower LDL
-
What is Niacin used for in dyslipidemic therapy?
borderline high lipidemia
can help reduce lipid
-
What are S/e of niacin
flushing
usually stops after 2 days
blut w/ ASA 45 min prior if not contraindicated
-
What do you monitor in dyslipidemic therapy?
- Vit D
- esp in elderly women
many meds fight w/ vit D
-
what do blood forming agents do?
help raise blood cells
often given to CA pt
-
S/e of blood forming agents
-
what are other blood forming agents?
- vit b12
- erythropoieten (procrit, epogen)
-
What is folic acid incompatible with
- calc
- iron sulf
- vit b complex
- vit c in same solution
-
how should liq iron be given
- through straw
- no teeth discolor
-
how should IM iron be givn
z-track
it is thick
-
what is needed on hand for iron dextran IV
emer equip
-
what should pt's taking b12 eath
- diet high in b12
- fish oysters egg yolk
- organ meet
- dairy
- clams
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