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What are the effects on the heart of digoxin?
- 1) Positive inotropic (increases myocardial contraction)
- 2) Negative chronotropic (decreases heart rate)
- 3) Negative dromotropic (decreases conduction of the heart cells)
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What is the significance of the lab value BNP?
Levels >100 diagnoses heart failure. It is released from the heart due to atrial stretching, which would indicate increased volume in the heart
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What is the therapeutic serum level of digoxin?
0.5 to 2.0 ng/ml
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What are the signs/symptoms of digitalis toxicity?
- 1) Bradycardia
- 2) dysrhythmias
- 3) headache
- 4) malaise
- 5) blurred vision
- 6) halos around objects
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What electrolyte imbalance can cause dig toxicity and what drugs can cause this imbalance?
1) Hypokalemia- loop diuretics, thiazide diuretics
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What are the effects of direct acting vasodilators?
Decrease venous return to heart, decrease cardiac filling, decrease oxygen demand on
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What are the effects of ACE inhibitors?
Dilates veins and arteries, decrease release of aldosterone, which reduces sodium and fluid retention
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What do diuretics do? Name a loop diuretic and a potassium sparing diuretic
Reduces fluid volume. Loop=Lasix, potassium sparing=aldactone
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How does the antianginal beta blockers help with angina?
Decreases heart rate and contractility, which decreases O2 demand and would relieve the pain of angina
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How does the antianginal nitrates help with angina?
Dilates veins which decreases preload and decreases O2 demand, which would relieve the pain of angina
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How does the antianginal calcium channel blockers help with angina?
Dilated arterioles which decreases afterload and decreases O2 demand, which would relieve the pain of angina. REMEMBER THIS: verapamil and diltiazem decrease heart rate and contractility
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What information do you need to know when giving nitrates for chest pain?
The sublingual tablet can be given every 5 minutes for up to three doses. If pain persists they should call for help. The tablets should not be exposed to heat and light until needed. They should be kept on a person and readily available for emergency use. Use can cause dizziness, faintness, and headache (acetaminophen can be given)
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What are the two main desired effects of beta blockers?
Decreases heart rate and decreases blood pressure (thereby decreasing cardiac output)
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What is a common side effect of ACE inhibitors?
Cough
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What is a common ending for an ACE inhibitor?
–pril (think of ACE hardware, pril=drill)
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What are some cultural considerations to keep in mind when administering medications?
- 1) African Americans have low-renin hypertension, and do not respond well to beta-blockers and ACE inhibitors.
- 2) Asian population excrete drugs more slowly, which can cause toxicity, so their dosage is usually decreased as compared with white population.
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What are the desired effects of alpha-adrenergic blockers?
Vasodilation, decreased blood pressure, decrease very low density lipoproteins and low density lipoproteins and increase high density lipoproteins (good lipoprotein)
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How do ACE inhibitors work?
They inhibit angiotension converting enzyme, which in turn inhibits the formation of angiotensin II and blocks the release of aldosterone. Normally, aldosterone causes sodium and fluid to be retained, so if we block its release, the body will excrete sodium and water
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How do calcium channel blockers work?
They decrease calcium levels which promotes vasodilation
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What is the desired effect of heparin?
It prevents clotting, used to prevent venous thrombosis
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What information do we need to know about low molecular weight heparin? (LMWH)
Lower risk of bleeding than heparin, frequent laboratory monitoring is not required, commonly called Lovenox, it is administered sub Q
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What tests do we need to monitor with warfarin (Coumadin)?
PT and INR. The INR for patients on warfarin should be 2-3
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What are antiplatelets used for?
Used to prevent thrombosis in arteries by suppressing platelet aggregation, used prophylactic for prevention of MI, prevents strokes
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What are thrombolytics used for?
To dissolve a clot and prevent ischemia and necrosis of tissue due to obstruction
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When would you not give a thrombolytic?
Recent CVA (stroke), active bleeding, severe hypertension, and anticoagulant therapy, recent traumatic injury
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What side effects do we need to monitor for when giving antilipidemics?
GI disturbances, headaches, muscle cramps (could indicate liver damage, also monitor liver enzymes)
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How long do people need to take antilipidemics?
For life
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