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. What would you like to do?
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?
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 ?
- 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
What are some causative factors of HF
- 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?
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
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?
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?
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,
- 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?
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?
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
- n/v/d- anorexia
- maculopapular rash,
In what pts is procainamide contraindicated
- complete heart block,
- 2nd and 3rd degree heart block
What are theraputic serum levels of procainamide?
What is Disopyramide known as?
What is Norpace used for?
adults w/ life-threatening ventricular tachydysrhthmias
What are the toxic serum levels of Norpace?
What are the theraputic levels of Norpace?
Where is Norpace excreted?
kidneys & liver in almost equal proportion
What kind of side effects can norpace have?
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?
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 ?
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?
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,
- 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
- 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?
- 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?
assess closely for Bradycardia
it will cause a decrease in heart rate which can = Bradycardia
What can propanalol cause?
- rash and itch
- Erratic blood sugars up and down
- Chest pain
- Joint pain
What is another name for propranolol?
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?
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?
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
When is Breviblock often given?
- during anesthesia
- other emergency situations when vent rate must be rapidly reduced
What is another name for Breviblock?
What kind of therapy is Breviblock not used for?
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?
What is another name for Lopressor ?
When is lopressor commonly given?
given after an MI to reduce risk of cardiac death
What are some conditions lopressor is used for?
- 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) ?
- blurred vision
What can be an issue w/ lopressor (metaprolol) @ 1st?
Safety will be an issue at first
What do you need to assess with lopressor?
- daily wt
What do you need to do right before giving Bp Meds?
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?
- myocardial contractility
What is the oldest beta blocker?
What is Inderal (propranolol) used for?
- supervent dysrhythmias,
- Used post MI, and for migraines
What is pheocromocytoma?
Adrenal gland tissue tumor
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?
what can pheocromocytoma cause?
- weight loss,
What is Betapace used for?
treatment of DOCUMENTED life-threatening vent dysrythmias such as sustained V tach
What is another name for betapace?
What can betapace cause?
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?
What is another name for Amiodarone
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?
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?
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
- heart failure
What is the most severe s/e of amiodarone?
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
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)
What is the only drug therapy available for rapid conversion into NSR fro a-fib/flutter?
How should Covert be given?
in a setting w/ ER personal & equipment close by
4 hours apart from other antidysrhythmics
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?
What is another name for Verapmil?
What is Cardizem not used for?
- 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
In what pt's are cardizem & Verpmil contraindicated for?
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?
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?
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*
- Urinary retention
- Hepatic/renal insufficiency
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?
- Anticholinergic’s- causes increased anti-cholinergic effects
- Anticoags- with quinidine
- Dig. and quinidine- increases serum dig levels
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
What reactions should be reported b pt's taking antidysrhytmics?
- Any increased cough,
- weight gain
How is Lidocaine administered
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?
- blurred vision,
What kind of antidysrhythmic drug is Adenosine?
What is Adenosine given for?
Whatdoes adenosine cause?
several seconds of asyystole when cardioverting tach to NSR
What is cardioverting?
converting abnormally fast heart rate or cardiac arrhythmia to a normal rhythm
how should Adenosine be given?
by rapid bolus injection
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?
What are the differant types of angina?
- Chronic Stable Angina
- Unstable Angina (USA)
- Vasospastic Angina
What is Chronic Stable Angina caused by?
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?
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?
- CALCIUM CHANNEL BLOCKERS
What drugs are most effective for CAD?
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,
- 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,
- 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
- 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?
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?
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?
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?
What substinces when taken w/ Nitrates/Nitrites cause severe hypotension?
- beta blockers,
How should you take po nitro
on an empty stomach
What does Tobacco use do to nitrates?
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
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?
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
What is another name for Isosorbide Dinitrate
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?
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
- Can cause impotence
Wha pt's should beta blockers and other vasodialaters not be used for?
WHat are some Beta Blockers used for Angina?
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?
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?
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?
- heart failure
- Constipation-esp in elderly
- Peripheral edema-esp pitting edema in extremeties
What do you watch for w/ CCB?
WHat are CCB's not used with?
- Beta blocker-additive effect -both lower BpDigoxin- can increase dig levels
- H2 blockers- increases CCB levelsTheophyline
- Trycyclic antidepressants
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?
- 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
What do vasodialators cause?
- post. Hypotension,
- but disappear after a few weeks of txt.
What do some vasodialators have in them?
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,
- 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?
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?
What is the Bp for stage 2 HTN?
What is the Bp for stage 3 HTN?
What is the Bp for stage 4 HTN?
> or = to 210/> or = to 120
What is the goal of HTN drugs
- Diastolic below 90
- decrease damage risks to kidneys,
WHat are the differant kinds of antihypertensives?
- Alpha 1 -adrenergic blockers
- Alpha 2- adrenergic receptor stimulators
What are antihypertensive drugs?
- Clonidine- (Catapres)
- ACE Inhibitors
- Lisinopril (Zestril, Prinivil)
- Captopril (Capoten)
- 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
What are some s/e of adrenergics?
- drowsiness, constipation
- 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?
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?
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,
WHat are some Alpha 2- adrenergic receptor stimulators drugs
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?
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
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?
What is the largest group of antihypertensives
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?
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?
- mood changes,
- Dry non-productive cough* that reverses if med stopped
- Loss of taste
- Rash and itching
What disease are ACE inhibitors not used in
What are S/S of ACE inhibitor OD?
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
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
•Oral an IV preps
•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:
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?
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?
What do topical Minoxidil & Rogaine used for
- used for hair growth,
- but can it cause hypotension
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?
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
- 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?
What must pt's on antihypertensives be wary of?
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?
What is Iron?
a O2 carrier in Hgb & myoglobin
What is Iron used in?
many enzyme reations in the body
Where is iron stored
- bone marrow
What does Iron deficiency cause?
Who requires the most iron?
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?
- stomach upset
- abd cramping
- black or red tarry stools
- can discolor tooth enamel & eyes
- causes pain upon injection
What is most common in OD death in pedi?
- 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?
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?
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?
- quinolones (antibiotics)
What are some iron supplements?
- ferrous fumarate (feostat, Hemocyte)
- Iron Dextran (INFeD)
What are Ferrous Furnarates
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 ?
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?
WHat are some foods with folic acid
- dried beans,
- 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
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
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
- 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
it is thick
what is needed on hand for iron dextran IV
what should pt's taking b12 eath
- diet high in b12
- fish oysters egg yolk
- organ meet
What would you like to do?
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