Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
53 Cards in this Set
- Front
- Back
What is the major cause of death in the US?
|
cardiovascular disease
|
|
3 main causes of CVD (cardiovascular disease)
Other contributing factors.... |
HTN
Diabetes Mellitus Increased Lipids Inactivity Smoking Obesity |
|
What is one of the most common admitting diagnoses after age 70?
|
CHF
|
|
What is one of the oldest, most effective groups of cardiac drugs that have been used for as the mainstay therapy for heart failure for over 200 years?
|
cardiac glycosides
|
|
What is the most frequently prescribed cardiac glycoside? This medication is derived from a plant, the foxglove. What type of effect on the heart do cardiac glycosides have?
|
Digoxin (Lanoxin) also digitalis
positive inotropic effect |
|
Which drug type affect the heart rate? (chronotropic, inotropic, dromotropic)
|
Chronotropic
|
|
Which drug type affect the conduction of electrical impulses through the heart?
|
Dromotropic
|
|
Which drug type affect the force of myocardial contraction?
|
Inotropic
|
|
The word "positive" before chronotropic, dromotropic, or inotropic means there is an ______ in contractility, rate, or conduction
|
increase
|
|
The word "negative" before chronotropic, dromotropic, or inotropic means there is an ______ in contractility, rate, or conduction
|
decrease
|
|
What effect do cardiac glycosides have on the inotropic?
|
positive (increased force of contraction, strengthens heart beat)
|
|
What effect do cardiac glycosides have on chronotropic?
|
negative (decrease heart rate)
|
|
What effect do cardiac glycosides have on dromotropic?
|
negative (decreased rate of electrical conduction, prolongs refractory period in conduction system.
multiple effects, but especially ↓ AV nodal conduction |
|
Cardiac glycosides ___ and _____ the heart beat.
|
Slow and strengthen
|
|
Indications (uses) of Digoxin
|
CHF/ Heart Failure, supraventricular dysrhythmias, atrial fibrillation
|
|
A digoxin level that is too high is very serious and can be fatal. What is this known as?
|
Dig toxicity
|
|
Digoxin has a very narrow therapeutic range. What is it?
Digoxin helps control _____ response in atrial fib/flutter, thereby controlling rapid ___ ___ in these ________. It promotes _____ due to improved ____ perfusion. |
Nurses must monitor the digoxin level, therapeutic is 0.8 - 2.0 ng
Digoxin helps control ventricular response in atrial fib/flutter, thereby controlling rapid heart rates in these dysrhythmias. It promotes diuresis due to improved renal perfusion (more blood flow to kidneys). |
|
Before giving Digoxin, the nurse must know what 3 things?
What are some side effects of digoxin? |
Apical pulse
Dig level Potassium level Side Effects: Can be very serious (fatal dig toxicity) CV- any type of dysrhythmia! GI- N/V, anorexia, diarrhea CNS- H/A, fatigue, malaise, confusion, convulsions Eye- flickering lights, colored vision (?), yellow lights or halos around objects. |
|
Hold Digoxin if:
|
Pulse is greater than 100 less than 60
(some books say greater than 120 or less than 50) Dig level is high Potassium level is low |
|
Low potassium levels potentiate the action of digoxin, leading to....
|
dig toxicity (Potassium can facilitate dig toxicity)
|
|
Nursing Implications for digoxin
What is the antidote? Patient teaching for digoxin |
Monitor dig level, K level, apical pulse
Monitor heart rhythm (telemetry) If toxicity is suspected, hold drug, call MD Antidote- digoxin immune fab Teaching: Teach pt. to take pulse, when to hold drug, when to call doctor. Instruct on importance of regular dig levels. Take in am, daily, don't double up if forgotten. Know s/s of dig toxicity and to report these Teach about s/s of worsening HF (as dig is used to treat CHF): SOB, ↑ fatigue, cough, wt. gain Report palpiations, dizziness (signs of tachcardia) teach how to take pulse and when to hold drug |
|
Nitrates are drugs that ____ blood vessels by relaxing _____ muscle cells in blood vessel wall. This causes the lumen of the vessel to get bigger and allows some fluid to be trapped in the periphery, which _____ the work load on the heart. They primarily cause venous vasodilation, reducing venous return, (the ___load). Nitrates have another effect on the heart.... what's that?
|
Nitrates are drugs that dilate blood vessels by relaxing smooth muscle cells in blood vessel wall.
This causes the lumen of the vessel to get bigger and allows some fluid to be trapped in the periphery, which decreases the work load on the heart. They primarily cause venous vasodilation, reducing venous return, (the preload) which reduces work load of heart. However, nitrates have potent vasodilating effects on coronary arteries, which improves coronary blood supply and decreases ischemia (angina). Nitrates also decrease BP. |
|
Nitroglycerin is a commonly prescribed nitrate often prescribed for people with ____ pectoris. There are long acting forms for stable AP for the routine prevention of anginal attacks. An example of this type is ____ (isosorbide dinitrate) and is given via ____ ____.
An _____ attack can be treated with a nitroglycerin via what route? This is taken episodic, PRN. |
Nitroglycerin is a commonly prescribed nitrate often prescribed for people with angina pectoris (AP). There are long acting forms for stable AP for the routine prevention of anginal attacks. An example of this type is Isordil (isosorbide dinitrate) and is given via transdermal patch (24 h).
An angina attack can be treated with a nitroglycerin sublingual, which is taken episodic, PRN. |
|
Nitroglycerin is stored in an ____ bottle because light can degrade the drug. Once opened it is good for ___ to ___ months even if exp. date is still current.
|
amber,
3-6 months |
|
Nitroglycerin comes in two forms:
|
transdermal and sublingual
|
|
Patients taking nitroglycerin should be taught to do what when taking drug? (2 things)
|
sit or lay down
Don't give on an empty stomach |
|
Nitroglycerin can cause a ____ because blood vessels in brain are _____. This usually diminishes over time. ______ or postural hypotension can also occur. Reflex _____ can occur as well because of vasodialtion which leads to SNS activation and then an increase in HR)
|
headache, dilated.
orthostatic tachycardia |
|
2 adverse effects of nitroglycerin are
|
orthostatic hypotension, reflex tachycardia
|
|
Before administering nitroglycerin, the nurse should check the patient's ___ _____. Change _____ gradually. Watch for possible additive, interactive effects: keep ointment off ____.
Assess for s/s of angina, change in pattern. Do patient teaching. |
Before administering nitroglycerin, the nurse should check the patient's blood pressure. (You want a baseline and you don't want BP to get too low) Change positions gradually. Watch for possible additive, interactive effects: keep ointment off hands (wear gloves).
Assess for s/s of angina, change in pattern. Do patient teaching. |
|
Patient teaching for nitroglycerin includes instruct to change position slowly, take with ____ to decrease headache, report ______ that doesn't get better over time. Instruct about 3 by 5 rule. Caution about additive effects from what 4 things?
|
Patient teaching for nitroglycerin includes instruct to change position slowly, take with food to decrease headache, report headache that doesn't get better over time. Instruct about 3 by 5 rule. Caution about additive effects from alcohol, Beta Blockers, Calcium Channel Blockers, **Viagra!** (sildenafil)
|
|
Patients taking nitroglycerin need to follow what rule? What does this mean?
|
3 by 5 rule: When angina occurs, the patient puts one nitroglycerin under the tongue and waits 5 min. If pain is still present, they can put another nitroglycerin under the tongue and wait 5 more minutes. Do this one more time if pain still present and if pain is not relieved, call an ambulance.
|
|
Beta Blockers are drugs that block the ....
|
beta 2 receptors
(They bind to beta receptor cells and block beta activity of the heart). |
|
Actions of Beta Blockers (3)
|
decrease force of myocardial contraction
decrease heart rate decrease rate of conduction through heart's electrical system (negative chronotropic, dromotropic, ionotropic) |
|
Beta Blockers reduce work of heart and also reduce the ______ ______ demand. Cardiac Output is vital to ____ supply of tissues.
|
myocardial oxygen
oxygen |
|
When are Beta Blockers used?
|
patients with angina
following an MI HTN migraines dysrhythmias (fast rhyhtms) |
|
Use caution when giving Beta Blockers with ____ because symptoms can get worse.
|
asthma (causes constriction of bronchiols)
|
|
What are 6 indications for beta blockers?
What are some nursing implications for the administration of beta blockers? Teaching? |
angina
post MI HTN (not 1st choice med) dysrhythmias migraines stage fright (not FDA approved yet) Take BP and pulse before admin. Monitor telemetry Expect to see a blunted response to exercise Additive/drug interactive effects with diuretics, anti-hypertensives Change positions slowly Teach patient how to take pulse. Monitor response to exercise by using "body signs" like SOB, fatigue (HR response will be decreased) Report SOB, asthma attach, especially in COPD or asthmatic patient. Diabetics need to monitor blood sugars. |
|
Many Beta Blockers end in ....
Beta blockers can mask the s/s of _______ so diabetics should be taught to closely monitor their insulin levels when taking these meds. What are some adverse effects of beta blockers? |
OL
hypoglycemia (especially masks tachycardia) Adverse Effects: bronchoconstriction due to blocking of beta 2 receptors in lungs which cause bronchodilation ↓ HR ↓ cardiac contractility ↓ CO dysrhythmias fatigue, weakness |
|
____ is a mineral needed for muscle contraction. Calcium Channel Blockers (CCB's) prevent calcium influx into ____ muscle ______ of heart and blood vessels. This promotes decreased ______ of heart muscle and vasodilation of ____ in body. Depressed conduction through SA and AV node (due to effect on Calcium channels) leads to decreased ___ ____ (esp. verapimil, diltiazem).
|
Calcium is a mineral needed for muscle contraction. Calcium Channel Blockers (CCB's) prevent calcium influx into smooth muscle channels of heart and blood vessels. This promotes decreased contractility of heart muscle and vasodilation of *arteries* in body. Depressed conduction through SA and AV node (due to effect on Calcium channels) lead to decreased heart rate (esp. verapimil, diltiazem).
|
|
There are calcium channels in ____ muscle and ____ walls.
CCB's have many uses. What are some? |
myocardial, vessel
angina HTN supraventricular tachycardias coronary vasospasm Migraines (vasospasm) Raynaud's disease |
|
When taking a Calcium Channel Blocker, the calcium channels are blocked and the vessels in the body _____
|
dilate
|
|
Calcium Channel Blockers are often used for people with ____because as the vessels dilate, the heart muscle receives more _____ ____
|
angina, oxygenated blood
|
|
Calcium Channel Blockers are also used for patients with h_____ and m_____. CCBs are generally well tolerated. What are some adverse effects?
|
HTN, migraines
CV: hypotension, palpitations, tachy/brady, dysrhythmias, heart failure (due to decreased contractile force of heart) GI: nausea, constipation Peripheral Edema Less common: rash, skin reaction |
|
4 main Adverse effects of Calcium Channel Blockers
|
hypotension, palpitations, dysrhythmias, heart failure
|
|
Nursing implications & Patient Teaching for administrations of Calcium Channel Blockers
|
check Pulse and BP 30 min prior to admin
Monitor telemetry if ordered Monitor adverse/ additive effects Hold med for excessive therapeutic response & contact MD (low BP, low HR, heart block) Grapefruit jiice may interact, reduce metabolism of CCB Teaching: Instruct on home monitoring of BP, HR Diet modifications: grapefruit juice Report excessive fatigue, palpiations, low BP ↓ or ↑ HR Clarify calcium misconceptions (bone loss) (CCBs have nothing to do with bones) |
|
ACE inhibitors are Angiotensin-converting enzyme inhibitors.
They block the enzyme, ACE, from converting Angiotensin ___ to Angiotensin ___. Angiotensin II is a potent _______ and leads to secretion of _____, a corticosteroid that causes the kidneys to hold on to water and sodium. ACE inhibitors block effects of Angiotensin II which results in ____ and _____ aldosterone secretion. |
ACE inhibitors are Angiotensin-converting enzyme inhibitors.
They block the enzyme, ACE, from converting Angiotensin I to Angiotensin II.. Angiotensin II is a potent vasoconstrictor and leads to secretion of aldosterone, a corticosteroid thAt causes the kidneys to hold on to water and sodium. ACE inhibitors block effects of Angiotensin II which results in vasodilation and decreased aldosterone secretion. |
|
ACE is produced in the _____ and travels to the _____ where angiotensin I is converted to angiotensin II
|
liver, kidneys
|
|
ACE inhibitors block the conversion of this potent ________ so the vessels can vasodilate. Vasodilation leads to decreased b____ p____. Decreased aldosterone leads to less ___ and ____ retention in the body. This is good for CHF and other fluid overload states, less circulating fluid decreases the work on the heart.
|
ACE inhibitors block the conversion of this potent vasoconstrictor, so the vessels can vasodilate. Vasodilation leads to decreased blood pressure. Decreased aldosterone leads to less fluid and sodium retention in the body. This is good for CHF and other fluid overload states, less circulating fluid decreases the work on the heart.
|
|
Vasodilation leads to a decreased BP. The body also gets rid of sodium and when that happens, water follows. The body tries to retain____ so it is important to check the level.
|
potassium
|
|
ACE inhibitors is often used for ____ and ____
|
HTN and CHF
|
|
ACE inhibitors usually end in 2 letters
|
iL
|
|
ACE inhibitors cause an adverse effect of a very annoying....
What are some other adverse effects? |
dry, nonproductive, acking cough, stops if med is stopped. Some patients can't handle it.
Fatigue dizziness H/A Hyperkalemia (with NA excretion K is retained) Hypotension Angioedema (rare but serious hypersensitivity reaction) |
|
When giving ACE inhibitors, nurse must assess patient's _____ _____ before administering. Also monitor electrolytes, especially ______. For CHF patient, monitor daily ____, ___ sounds, and other s/s of heart failure. Assess for development of ___ over time. Also, with the elderly, assess renal function, especially ____ and ___ ___ tests.
Patient teaching.... |
When giving ACE inhibitors, nurse must assess patient's blood pressure before administering. Also monitor electrolytes, especially potassium. For CHF patient, monitor daily weight, lung sounds, and other s/s of heart failure. Assess for development of cough over time. Also, with the elderly, assess renal function, especially BUN and creatinine clearance test.
Patient teaching: Change position slowly, monitor BP regularly, take with food if you get a headache. If CHF, report s/s of fluid retention and monitor DW. |