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Digoxin is contraindicated when?
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?
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)