Digoxin is contraindicated when?

HR is

This electrolyte imbalance increases the effect ofdigoxin

Hypokalemia

Classic s/s of Digoxin toxicity

visual disturbances - Halos around objects

Digoxin's action

Increases contractility, dereases AV conduction

Antidote for Digoxin

Digibind

Nitrates action

vasodilation

Nitrates are used for what?

Angina

Side effects of nitrates

headache, hypotension, dizziness, syncope,circulatory collapse

Nitroglycerin comes in what forms

sublingual, transdermal patch, extended releasetablet, translingual spray

How is nitrogylcerin stored?

dark, glass bottle (not child proof)

Client should feel this when nitro is put undertongue?

A tingle or burning

How is nitro taken for angina?

can take one tablet under tongue every 5 minutesfor a total of 3 doses

What s/s may the client have after taking nitro?

headache, dizziness, syncope, - client can takeTylenol for headache

When dc'ing nitro patch what is the procedure?

taper down over several weeks

What is important to know about IV nitroglycerin?

Must use special tubing

What is the action of sodium channel blockers?

decreases the rate of conduction in Purkinjie Fibers

Antihypertensives are contraindicated for whatconditions?

2nd and 3rd Degree heart blocks

Side effects of lidocaine (Xylocaine) andmexiletine (Mexitil) important to teach men about?

Impotence, may be permanent

Lidocaine (Xylocaine) is admin in what form?

IV

Flecaindide (Tambocor) and propafenone(Rythmol) are used for what heart rhythms?

life threatening ventricular dysrhythmias

What is the action of Beta Blockers?

Block catecholamines and cause peripheralvasodilation

Beta Blockers are used for what heart conditions?

Hypertension, some tachy arrhythmias and angina

Beta Blockers are contraindicated in what heartconditions?

2nd and 3rd degree heart block and bradycardia

What are side effects of Beta Blockers?

Bradycardia, complete heart block, hypotensin,Raynaud's phenomenon, insomnia

What can Beta Blockers mask the signs of that isimportant for Diabetics to know?

It can mask the signs in hypoglycemia (clientshould do more finger stick blood sugar tests)

What do all clients need to do before taking a BetaBlockers?

Check pulse, do not take if

What can occur if Beta Blockers are stoppedabruptly?

Rebound Hypertension

Beta Blockers may cause this what type ofdysfunction?

sexual

What is the action of potassium channel blockers?

increases refractory period (slow HR)

What are potassium channel blockers used for?

atrial fibrillatin, venricular fibrillation, and V-tach

Potassium channel blockers are contraindicated inwhat heart conditions?

2nd & 3rd Degree Heart block, bradycardia, SAnode dysfunction

What are the side effects of potassium channelblockers?

Photophobia, hypotension, dysrhytmias

What is important to know about Amiodaronewhen given IV?

A filter is required, it precipitates.

What labs must be monitored with potassiumchannel blockers?

potassium and magnesium levels

What is the action of calcium channel blockers?

decrease AV conductivity and SA & AVautomaticity

CCBs are used for what heart conditions?

Angina, SVTs, Hypertension

What are side effects of CCBs?

Hypotension, Palpitations, Tachycardia, rash &flushing, peripheral edema

CCBs are contraindicated with what heartcondition?

AV node dysfunction

What are important teaching topics for clientstaking CCBs?

Take BP and pulse and watch for orthostatichypotension

What is adenosine used for?

Chemical cardioversion, causes temporaryasystole!

CO x PR =

Blood Pressure

SV X HR =

Cardiac output

Normal BP

Prehypertension

120-139 80-89

Stage 1 hypertension

140-159 90-99

Stage 2 hypertension

>160 >100

What is the action of centrally acting adrenergics?

stimulate alpha 2 receptors, inhibits alpha 1(decreases sympathethic activity)

Name two centrally acting adrenergics

clonidine(Ctapress) and methyldopa (Aldomet)

What are the side effects of alpha adrenergics?

hypotensino, drowsiness, dry mouth, dizziness

What can happen if centrally acting alphaadrenergics are stopped suddenly?

rebound hypertension

What is the action of peripherally actingadrenergics?

inhibits release of norepinepherin and diminishesNE stores

What are is a more serious side effect ofperipherally acting alpha adrenergics?

depression (also diminishes serotonin)

What are side effects of peripherally actingadrenergics?

hypotension, dry mouth, drowsiness, sedation,constipation, orthostatic hypotensin

What is the action of ACE inhibitors?

blocks the conversion of angiotensin I toangiotensin II and blocks release of aldosterone

ACE inhibitors decrease ?

preload

What diuretic can cause ototoxicty when admintoo fast with IV infusion?

Lasix (furosemide)

What group of diuretics is commonly combinedwith ACE inhibitors?

Thiazide diuretics

What are common electrolyte imbalances withthiazide diuretics?

Hypokalemia, hypomagnesemia, hypercalcemia

What other imbalances can thiazides cause?

hypergylcemia, hyperuricemia, hyperlipidemia

Thiazides are contraindicated in what patients?

renal faliure patients

What must the nurse monitor for in patients takingthiazides?

VS, weight, I/Os, E-lytes

What are signs of hypokalemia to teach patients?

muscle weakness, leg cramps, dysrhythmias

What else must you teach clients taking thiazidesto do or watch for?

Take BP, watch for orthostatic hypotension, usesun block, eat foods rich in potassium

Loop diuretics are more potent than thiazides asdiuretics, why are not not prescribed as often?

less effective as antihypertensives

What drug does loop diuretics have a majorinteraction with?

Digoxin --> can cause digoxin toxicity

Clients should take diuretics at what time of theday?

Early morning to prevent nocturia

What is important to teach about potassiumsparring diuretics?

monitor potassium levels periodically, do not takepotassium supplements

Potassium sparring diuretics should not be takenwith what class of heart medications?

ACE inhibitors (both can cause hyperkalemia)

What is the action of vasodilators?

act directly on arteriole smooth muscle; decreasestroke volume resistance = decreases afterload

When are vasodilators used?

hypertensive emergenices and cute heart failure

Name the 3 vasodilators and what form are theyadmin in?

hydralazine (apresoline) oral, minoxidil (oral) andsodium nitroprusside (Nipride) IV - for malignant

hypertension

What do platelet inhibitors do?

inhibit aggregation of platelets (decrease clotting)

What are side effects of platelet inhibitors?

uncontrolled bleeding

Do platelet inhibitors affect existing clots?

no effect on thrombi

What platelet inhibitor is commonly given afterand acute MI?

aspirin

GP IIB and IIIA inhibitors are classified as what?

potent platelet inhibitors

What are IIB and IIIA inhibitors used for?

unstable angina, some heart attacks, angioplastywith or without stent placement

What is a common drug from the IIB IIIAinhibitors?

colpidogrel (Plavix)

How long before surgery must a client stop takingPlavix?

7 days

The IIB IIIA drugs are contraindicated for clientswith what conditions?

bleeding ulcer or intracranial hemorrhage

What is the action of antiplatelets?

interrupt clotting process

When are anticoagulants used?

after MI, PE, DVT and ischemic CVA

What is a posible serious side effect of heparin andLMWHs?

Herparin indiced thrombocytopenia, platelet countbelow 150,000

Name a common LMWH.

enoxaparin (Lovenox)

What are some advantages to LMWHs?

no need to monitor PTT, once day dosing, lowerincidence of HIT

What is the antidote for Heaprin?

Protamine Sulfate

What is the disadvantage for LMWHs overdose?

protamine sulfate has no effect and it has a longerduration of action

Name a very LMWH and what is its advantage ofLMWHs?

fondaprinux (Arixta) - greater reduction of rick forHIT

What is the antidote for Coumadin (warfarin)?

Vitamin K

What lab do you monitor for Heparin?

aPTT

What labs are monitored for Coumadin (warfarin)

PT or INR

What should PT be?

1.5 - 2.5 X control

What should INR be?

2.0 - 3.0

What is the normal platelet count?

150,000 - 450,000

Client teaching for clients taking anticoagulants?

tell dentist, use soft toothbrush, use electric razor,carry medical ID, do not smoke, do not takeaspirin, do ot take herbs (many interact with

anticoagulants), avoid alcohol

If clients expericen bleeding when takinganticoagulants what do they need to do?

apply firm, direct pressure for 5-10 minutes

Clients taking anticoagulants need to report whats/s to MD

petechiae, bruising, tarry stools, epistaxis,expectoration of blood

What foods must clients taking anticoagulantsavoid?

green leafy veggies, fish, liver, coffee, tea (all richin vitamin K)

What do thrombolytics do?

directly break up clots

What is the antidote for thrombolytics?

aminocaproic acid (Amicar) it is given to stopbleeding

What are some s/s of thrombolytics?

itching, ever, flushing, hives, dyspnea,bronchospasm, hypotension

What dtugs must must be avoided when takingthrombolytics?

NSAIDs

Total cholesterol level goal

trigylceride level goal

40-150

LDL goal

HDL goal

>40

What are serious side effects of statins?

elevation of liver enzymes and rhabdomylosis

How long does it take for full therapeutic effecttake for statins?

2-4 weeks

What can happen if client abruptly stop takingstatins?

3 fold rebound effect on cholesterol; can causedeath from AMI

What food must be avoided when taking statins?

Grapefruit and grapefruit juice

What is the combination drug that decreasessynthesis if cholesterol in the liver and decreases

serum lipid levels?

Vytorin (ezetimbie/simvastatin)