Pharm IV

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  1. What does the cardiovascular system do?
    • transports nutrients,
    • wastes, gases, and hormones through the body
  2. 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
  3. WHat kind of action do cardiac drugs have on the urinary system?
    direct/indirect action
  4. When does heart failure occur
    when the heart cannot pump enough blood to meet tissue needs for oxygen and nutrients
  5. What is systolic dysfuncdtion
    impaired myocardial contraction during systole
  6. What is diastolic dysfunction?
    impaired relaxation and filling of ventricles during diastole
  7. what has HF been referred to as ?
    • congestive heart failure (CHF)
    • there is frequently congestion (fluid accumulation) in the lungs and peripheral tissues
  8. 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
  9. 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
  10. what are the most common conditions that lead to HF?
    • Coronary artery disease
    • hypertention
  11. What are some causative factors of HF
    • hyperthyroidism
    • excessive IV fluids/blood transfusions
    • drugs that decrease the force of mycocardial contractions
    • drugs that cause sodium & water retention
  12. 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
  13. What are some feedback mechanisms that activate in HF
    increased sympathetic activity & circulating catecholamine

    activation of renin angiotension-aldosterone system
  14. what do increased sympathetic activity & circulating catecholamines in HF do?
    increase the force of myocardial contraction increase heart rate causes vasoconstriction
  15. 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
  16. What is Renin
    An enzyme produced in the kidneys in response to impaired blood flow and tissue perfusion
  17. What does renin do in the bloodstream
    stimulates the production of a powerful vasoconstrictor - angiotensin II
  18. What do arterial vasoconstriction do?
    impairs cardiac function by increasing the resistance against which ventricle ejects blood (afterload)
  19. What does increased afterload of the heart do
    • raises filling pressures inside heart
    • increases stretch & stress on myocardial walls
    • redisposes to subendocardial ischemia
  20. what do pts w/ severe HF have
    constricted arterioles in cerebral myocardial, renal, hepatic & mesenteric vascular beds

    increased organ hypofusion & dysfunction
  21. WHat causes increased organ hypoperfusion & dysfunction?
    constricted arterioles
  22. What is preload?
    • diastolic ventricular filling pressure
    • amount of venous blood returning to the heart
  23. What does angiotensin II do?
    • stimulating aldosterone release from adrenal cortex &
    • vasopressin (antidiuretic hormone) from posterior pituitary

    these promotes sodium & water retention
  24. What is afterload?
    amount of resistance in the aorta peripheral blood vessels that the heart must overcome to pump effectively
  25. What are the main S/S of HF
    dyspnea & fatigue --> exercise intolerance & fluid retention--> pulmonary congestion & peripheral edema
  26. WHat is compensated HF
  27. 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
  28. what causes edema & jugular vein distention?
    congestion of veins & leakage of fluid into tissues
  29. what is S/S of acute, severe cardiac decompensation?
    pulmonary edema (req immediate treatment)
  30. What are HF drugs for
    • to try to improve circulation
    • alter compensatory mechanis
    • reverse heart damage
  31. what is the only commonly used digitalis glycoside?
    Digoxin (lanoxin)
  32. What are antidysrhythmic agents used for
    prevention and treatment of cardiac dysrhythmia
  33. when do dysrhythmias become a problem?
    when they interfere with cardiac function & the ability to perfuse body tissues
  34. What is automaticity of the heart?
    the heart's ability to generate an electrical impulse

    electrical impulse formation
  35. what is exitability of the heart?
    the ability of cardiac muscle cell to respond to electrical stimulus
  36. What is conductivity?
    ability of cardiac tissue to transmit electrical impulses
  37. What is dysrhythmia?
    any disturbance or abnormality in the normal cardiac rhythm

    - feels as a skipped beat
  38. when are dysrhythmias clinically significant?
    when the interfere with cardiac function
  39. What do antidysrhythmic drugs do?
    alter the heart's electrical conduction system
  40. How are antidysrhythmic drugs usually classified
    • according to their mechanisms of action
    • effects on conduction system
  41. What is the goal of antidysrhythmic drug therapy?
    • to prevent/relieve symptoms
    • prolong survival
  42. What do drugs for rapid dysrhythmia do
    • reduce automaticity
    • slow conduction of electrical impulses through heart
    • prolong refactory period of myocardial cells
  43. What are some Class I (Sodium Channel Blockers (membrane stablizers) antidysrhythmics?
    • Norpace
    • Procanamide
    • Quinidine
    • Lidocaine
  44. What are Class I antidysrhythmic drugs?
    Sodium Channel Blockers (membrane stablizers)
  45. How do Class I antidysrhythmic drugs work?
    interferes with the sodium channels and stabilizes the hearts excitability
  46. 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
  47. What does Quinidine do?
    • reduces automaticity
    • slows conduction
    • prolongs refractory period
  48. What does Quinidine do to electrical impulses?
    accelerate their rate
  49. What can Quinidine cause?
    • loss of hearing,
    • blurred vision,
    • GI upset,
    • tinitus,
    • diarrhea,
    • n/v
    • vertigo
    • thrombocytopenic pupura (TTP)
    • decreased blood flow to the brain
  50. 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.
  51. 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
  52. Wher is Quinidine metablized and excreted?
    • metab: liver
    • excreted: urine
  53. What are the theraputic levels of Quinidine?
    2-5 mcg/mL
  54. What are toxic serum levels of Quinidine?
    > 5 mcg/mL
  55. in what pts is quinidine contraindicated?
    • severe, uncompensated HF
    • w/ heart block
  56. What is procainamide used for?
    atrial and ventricular tachy-dysrhythmias
  57. What is procainamide most effective for?
    • suppressing premature Vent contractions
    • preventing the recurrence of V tach
  58. What can procainamide cause
    high incidence of adverse effects

    • lupus-like syndrome
    • n/v/d- anorexia
    • fever,
    • leucopenia,
    • maculopapular rash,
    • itching/flushing
  59. In what pts is procainamide contraindicated
    • Lupus,
    • complete heart block,
    • 2nd and 3rd degree heart block
  60. What are theraputic serum levels of procainamide?
    4-8 mcg/mL
  61. What is Disopyramide known as?
  62. What is Norpace used for?
    adults w/ life-threatening ventricular tachydysrhthmias
  63. What are the toxic serum levels of Norpace?
    > 8mcg/mL
  64. What are the theraputic levels of Norpace?
    2-8 mcg/mL
  65. Where is Norpace excreted?
    kidneys & liver in almost equal proportion
  66. What does norpace cause?
    • wider QRS
    • hypotension
  67. What kind of side effects can norpace have?
    • prodysrhthmiic
    • anti-cholinergic
  68. in what pts is norpace contraindicated?
    with poor left vent function
  69. How does the incidence of lupus w/ norpace compare to procanamide
    less than that of Procanamide
  70. What are class II antidysrhythmic drugs?
    beta blockers
  71. What kind of beta blockers are there?
    • selective (1)
    • nonselective (1&2)
  72. 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
  73. What kind of dysrhythmia are ClassII effective against?
    dysrhythmia from excessive sympathetic activit
  74. What are Class II (Beta blockers) antidysrhythmics most often used for?
    to slow the ventricular rate of contraction in atrial flutter & a-fib
  75. 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
  76. When are Beta Blockers especailly beneficial ?

    after an MI

    because many catecholamines are released at that time and can make the heart hyperirritable
  77. What is the reduction rate of cardiac death after an MI for pt on Class II antidysrhythmics?
  78. What cells do Class II block?
    Beta 1, 2 & 3 adrenergic receptors
  79. What system are Beta adrenergic receptors part of ?
    - part of the SNS (fight or flight)
  80. Where are β 1-adrenergic receptors mainly located?
    in the heart and in the kidneys
  81. Where are β 2-adrenergic receptors mainly located?
    • in the lungs,
    • gastrointestinal tract,
    • liver,
    • uterus,
    • vascular smooth muscle,
    • skeletal muscles
  82. Where are β 3-adrenergic receptors located
    in fat cells
  83. What do most Beta Blockers (class II) drugs end in?
    • “lol”
    • ex: Metoprolol
  84. What is usually the 1st sign of impending hypotension?

    What are other signs

    • pulse: <60
    • Systolic BP <90mmHg
  85. What do you do if pt is experiencing hypotension on Beta blockers?
    withhold the beta blocker and contact a Dr.
  86. What are some Beta Blocker (Class II antidysrhythmic) drugs?
    • Propranalol
    • Tenormin (Atenolol)
    • Breviblock (Esmolol)
    • Lopressor (Metoprolol)
    • Inderal (Propranolol)
    • Betapace (Sotalol)
  87. What is propanalol commonly used for?
    for acute sinus tachy
  88. What do you need to do for propanalol?

    assess closely for Bradycardia

    it will cause a decrease in heart rate which can = Bradycardia
  89. What can propanalol cause?
    • Bradycardia
    • rash and itch
    • Erratic blood sugars up and down
    • Chest pain
    • Joint pain
  90. What is another name for propranolol?
  91. What do you need to report when taking propanalol?
    • SOB
    • skin rash
  92. WHat does Tenormin (Atenolol) block?
    beta-1’s on the heart
  93. What is another name for Tenormin?
  94. What is Tenormin used for?
    angina and hypertension
  95. for what pts is Tenormin contraindicated for?
    with severe bradycardia, CHF and cardiogenic shock
  96. What is Breviblock?
    shorter acting beta-blocker
  97. What does Breviblock block?
    Beta 1
  98. What is Breviblock used for?
    SVT (supraventricular tachycardia)

    dysrythmias that originate above the ventricals and are fast
  99. What can breviblock be used for?
    • tachyarrythmias that occur after an acute MI
    • to control hypertension
  100. What beta blocker has a rapid onset & short duration of action
  101. When is Breviblock often given?
    • during anesthesia
    • surgery
    • other emergency situations when vent rate must be rapidly reduced
  102. What is another name for Breviblock?
  103. What kind of therapy is Breviblock not used for?
  104. In what pts is breviblock contraindicated?
    • with asthma
    • for those with 2nd or 3rd degree heart block or CHF
  105. What does Breviblock tend to exacterbate?
  106. What is another name for Lopressor ?
  107. When is lopressor commonly given?
    given after an MI to reduce risk of cardiac death
  108. What are some conditions lopressor is used for?
    • hypertension,
    • angina,
    • acute myocardial infarction,
    • supraventricular tachycardia,
    • ventricular tachycardia,
    • congestive heart failure
    • prevention of migraine headaches
  109. What can lopressor used for?
    treatment of hypertension and angina
  110. WHat does LOPRESSOR HCT contain?
    a hydrochlorathiazide diuretic
  111. What is lopressor HCT used for? ?
    To diurese the patient, thus decreasing Bp
  112. What kind of Beta blocker is lopressor?
    Selective- beta 1’s
  113. What are some s/e of lopressor (metaprolol) ?
    • hypotension,
    • dizziness,
    • blurred vision
    • etc
  114. What can be an issue w/ lopressor (metaprolol) @ 1st?
    Safety will be an issue at first
  115. What do you need to assess with lopressor?
    • electrolytes
    • bp
    • I&O
    • daily wt
  116. What do you need to do right before giving Bp Meds?
  117. WHat kind of betablocker is Inderal (propranolol)?
    is nonspecific (beta 1 and 2- works on receptors in the heart and lungs!)
  118. What does Inderal (propranolol) reduce?
    • HR
    • myocardial contractility
  119. What is the oldest beta blocker?
    Inderal (propranolol)
  120. What is Inderal (propranolol) used for?
    • hypertension,
    • angina
    • VTach,
    • supervent dysrhythmias,
    • pheocromocytoma*
    • Used post MI, and for migraines
  121. What is pheocromocytoma?
    Adrenal gland tissue tumor

    rarely canerous
  122. What causes pheocromocytoma?
    the release of too much epinephrine and norepinephrine- controling heart rate, metabolism, and blood pressure
  123. What problems does does pheocromocytoma usually cause
    problems in controlling HR< metab, BP
  124. in what life stage group is pheocromocytoma common in?
    early middle-adulthood
  125. what can pheocromocytoma cause?
    • tachy,
    • weight loss,
    • irritability
    • palpitations
  126. What is Betapace used for?
    treatment of DOCUMENTED life-threatening vent dysrythmias such as sustained V tach
  127. What is another name for betapace?
  128. What can betapace cause?
    new dysrhythmias
  129. in what pt is betapace contraindicated for?
    • bronchial asthma ,
    • sinus brady or cardiogenic shock
  130. What are class III antidysrhythmics most commonly used for?
    to treat dysrhythmias that are difficult to treat
  131. What are class III antidysrhythmics?
    Potassium Channel blockers
  132. What are Class III antidysrhythmics used for?
    the conversion of A-fib and flutter to a NSR(normal sinus rhythem)
  133. What are most Class III antidyrhytmics used for?
    difficult to treat dysrhthmia
  134. What antidysrhythmic class is still somewhat investigational?
    Class III
  135. What is another name for Amiodarone
  136. 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
  137. What kind of drug are Class III antidysrhtymics?
    • big gun
    • not 1st line
  138. What has Amiodarone been shown to effect?
    atrial dysrhythmias that are resistant
  139. What is bad with Amiodarone?
    Has a lot of unwanted s/e-
  140. what does Amiodarone contain?
    IODINE in it’s structure (watch for allergies)
  141. What can Amiodarone cause?
    therefore can cause hyper or hypo- thyroidism
  142. What do you need to assess before giving Amiodarone?
    thyroid function
  143. with Amiodarone at what dosage do you see more likely to see unwanted s/e's
    Doses exceeding 400mg/D
  144. What are the most common s/s of Amiodarone?
    corneal microdeposits- causes halo’s, dry eyes & photophobia
  145. in what amiodarone pt's do corneal microdeposits occur
    Occurs in almost all adults on the med for 6 months or more
  146. What effects do amiodarone have?
    vasodilating effect
  147. What does amiodarone do?
    decrease systemic vascular resistance prolongs conduction in all cardiac tissue decreases heart rate
  148. What are some unwanted s/e to amiodarone ?
    • serious/potentially fatal pulmonary toxicity
    • may begin w/ progressive dyspnea
    • cough w/ crackles
    • dercreased breath sounds
    • pleurisy
    • heart failure
    • hepatotoxicity
  149. What is the most severe s/e of amiodarone?
    pulmonary toxicity
  150. What is an important property of amiodarone?
    it is lipophilic- loves to migrate to adipose tissue
  151. in what forms is Bretylium available in?
    Only available IV
  152. What is Bretlium used for?
    to treat life-threatening V-tach or fib
  153. What is Bretylium primarily used for?
    Used primarily in a code situation
  154. What does Bretylium cause?
    postural hypotension in 50% of patients
  155. What does Bretylium do?
    Slows conduction of ventricular portion of muscle
  156. What is Bretylium?
    adrenergic blocking (slows release of norepi)
  157. What can Bretylium cause
  158. How is Bretylium given?
    Given slow IV to reduce s/e
  159. Wher is Bretylium usually given?
    usually only in ICU/ambulance
  160. What is Covert indicated for?
    recent onset of ATRIAL dysrhythmias (A-fib and flutter)

  161. What is the only drug therapy available for rapid conversion into NSR fro a-fib/flutter?
  162. How should Covert be given?
    in a setting w/ ER personal & equipment close by

    4 hours apart from other antidysrhythmics

    very cautiously
  163. in what form should Covert be adminisstered?
    Only IV and specifically weight based
  164. What are Class IV antidysrhythmics?
    (Calcium channel blockers)
  165. what are Calcium channel blockers (class IV) used for?
    for the treatment of hypertension and angina
  166. What do Calcium channel blockers do?
    Slows or blocks the calcium channels of the cell into the myocardium
  167. What are the Class IV antidysrhythmic drugs?
    • Cardizem
    • Verapamil
  168. What is another name for Cardizem?
  169. What is another name for Verapmil?
  170. What is Cardizem not used for?
    • MI,
    • pulmonary congestion,
    • severe hypotension,
    • cardiogenic shock,
    • sick-sinus syndrome,
    • 2nd/3rd degree heart block
  171. What is Cardizem used for?
    • Angina
    • Antidysrhythmic
  172. What is Verapmil (Calan) used for?
    • to prevent and convert recurrent PSVT( paroxysmal SVT) to control vent response in a-fib or flutter
    • Angina
  173. In what pt's are cardizem & Verpmil contraindicated for?

    digoxin toxicity

    may worsen heart block
  174. What does Verapmil precipitate with?
    •Precipitates with Nafcillin and Sodium Bicarb
  175. what drug should not be put into the same IV asVerapmil?
    beta blockers
  176. What are Nitratesoften taken with
    often taken WITH Calcium Channel Blockers
  177. Why do you need to be careful when giving Antidysrhythmics to elderly?
    increased side effects- weakness and dizziness (safety)
  178. What can nicotine do to Antidysrhythmics?
    decrease effectiveness
  179. What effects can ETOH have on antidysrhythmic drugs?
    increase hypotensive episodes
  180. What happens if you abruptly stop taking antidysrhythmic?
    can have a rebound effect
  181. What do you assess for when giving antidysrhythmic ?
    • •Not used in: Hypersensitivity
    • CHF- can worsen effects of CHF
    • Complete heart block*
    • Hypotension
    • MG
    • Urinary retention
    • Hepatic/renal insufficiency
  182. What is Heart Block?
    A heart block can be a blockage at any level of the electrical conduction system of the heart
  183. WHat drugs interact with antidysrhythmics?
    • •NMBA’s
    • Anticholinergic’s- causes increased anti-cholinergic effects
    • Anticoags- with quinidine
    • Dig. and quinidine- increases serum dig levels
    • Cimetadine/Nefedipine
    • Anticonvulsants
  184. What should be done when giving antidysrhythmics?
    • Initial EKG and VS
    • monitor these closely throughout course
  185. What should be done with IV antidysrhythmics?
    have on pump
  186. What kind of monitored should pt's on IV antidysrhythmics be on?
    continous cardiac monitor
  187. What are some adverse reactions you should watch for w/ pt's on antidysrhythmic drugs?
    • heart block
    • dysrhythmias
    • hypotensioin
  188. What reactions should be reported b pt's taking antidysrhytmics?
    • Any increased cough,
    • SOB,
    • weight gain
  189. How is Lidocaine administered
  190. How does Lidocaine work?
    It increase the electricalimpulses and weak impulses are weeded out
  191. What does lidocaine do?
    it slows the heart rate overall
  192. What do you asses for when giving lidocaine?
    • tinitus,
    • blurred vision,
    • HA/dizziness,
    • seizures,
    • hallucinations
  193. What kind of antidysrhythmic drug is Adenosine?
  194. What is Adenosine given for?
  195. Whatdoes adenosine cause?
    several seconds of asyystole when cardioverting tach to NSR

  196. What is cardioverting?
    converting abnormally fast heart rate or cardiac arrhythmia to a normal rhythm
  197. how should Adenosine be given?
    by rapid bolus injection

  198. What should you do when giving Adenosine?
    • Educate
    • be supportive
  199. What is Angina?
    The ACHING of the heart muscle due to insufficient oxygen in the blood
  200. in angina usually idiopathic?
  201. What are the differant types of angina?
    • Chronic Stable Angina
    • Unstable Angina (USA)
    • Vasospastic Angina
  202. What is Chronic Stable Angina caused by?
  203. What can trigger Chronic Stable Angina?
    exertion or stress (cold, fear, emotions)
  204. What can exacerbate Chronic Stable Angina?
    Smoking, drugs, etoh, caffeine, coffee
  205. What are some s/s of Chronic Stable Angina?
    Intense pain that subsides in about 15 minutes
  206. What is Unstable Angina an early stage of?
    early stage of progressive CAD
  207. what can Unstable Angina progress to over the years
    May end in MI in sunsequent years
  208. What are s/s of Unstable Angina?
    Pain increases in severity with each attack and attacks become more frequent
  209. When can Unstable Angina occur?
    Can happen at rest when condition progresses
  210. What is Vasospastic Angina?
    spasms of the smooth muscle layers that surround the atherosclerotic coronary arteries
  211. When does Vasospastic Angina usually occur?
    at rest
  212. WHat is an aspect of -asospastic Angina?
    Seems to follow a regular pattern- occurring around the same time of day
  213. WHat drugs are used to treat Angina?
  214. What drugs are most effective for CAD?
  215. What do NITRATES/NITRITES act on?
    Act on vascular smooth muscle- relaxes arterial and venous circulation
  216. What are Nitrates/Nitrites
    NITROGLYCERIN: (Rapid acting)
  217. What pt's are Nitrates/Nitrites contraindicated for?
    • with ICP,
    • inadequate cerebral perfusion,
    • pericarditis,
    • pericardial tamponade (fluid accumulation in the heart causing increased pressure),
    • severe hypotension,
    • severe anemia
  218. Where are oral Nitrates/Nitrites metabolized?
    metabolized in the liver- a lot is removed from circulation (LARGE first-pass effect)
  219. How are Nitrates/Nitrites usually given?
    • given SL or Buccal so bypasses the first pass effect
    • Can be administered transdermally
  220. for what conditions are Nitrates/Nitrites given IV?
    • acute MI,
    • CHF,
    • Pulmonary edema
  221. What does giving Nitrates/Nitrites topically do?
    bypasses first pass effect- allows for slow delivery of the drug
  222. How do you administer Nitrates/Nitrites transdermal patchs?
    usually OFF for 8 hours at night, new patch in the AM (review)
  223. What do Nitrates/Nitrites do?
    •Dilates all blood vessels, but mainly effect those in the venous circulation
  224. What do Nitrates/Nitrites do in small doses?
    Slight arterial dilation in low doses
  225. What are some s/e of Nitrates/Nitrites?
    • HA is most common- can be very severe
    • Tachycardia
    • Postural Hypotension
  226. What should you do if pt gets postural hypotension from Nitrates/Nitrites?
    • assess laying, sitting and standing
    • educate safety
  227. What causes cause increased anti-hypertensive effects with Nitrates/Nitrites?
    • ETOH,
    • phenothiazines,
    • CCB’s

    safety is an issue
  228. WHat is the 1/2 life of Nitrates/Nitrites?
    1-4 minutes- readily absorbed
  229. WHat are s/s of postural hypotension?
    • flushing,
    • dizziness,
    • sweating,
    • syncope
  230. in what pt's is the safety of taking Nitrates/Nitrites still being investigated?
    with acute MI
  231. in what pt's is Nitrates/Nitrites transdermal patch showing good performance?
    recent MI
  232. How often do you need to renew Nitro Rx?
    every 3 mo-loses strength
  233. What does Nitro cause?
    a throbbing headache- it is a potent medication
  234. What can you take for HA cause by Nitro?
  235. What substinces when taken w/ Nitrates/Nitrites cause severe hypotension?
    • ETOH
    • beta blockers,
    • narcotics,
    • antihypertensives,
    • vasodilators
  236. How should you take po nitro
    on an empty stomach
  237. What does Tobacco use do to nitrates?
    reduces effects
  238. What does Nitroglycerin do to VMA lab levels?
    increases VMA (vanillylmandelic acid) levels (end stage metabolite of epi and norepi)
  239. What is SL Nitroglycerin used for?
    for CP- ASAP
  240. What do you need to educate pt to do w/ SL Nitroglycerin?
    •Educate to keep on their person at all times
  241. What should SL Nitroglycerin pt's do if they feel CP?
    lay down w/ feet up take dose
  242. What does a SL Nitroglycerin pt do if they inf they don't get relief from CP after 2 doses?
    • call 911
    • take 3rd dose
  243. how long should SL Nitroglycerin pt's wait b/w doses if having CP
    3-5 min
  244. 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
  245. What is needed when giving IV Nitro?
    ICU monitoring
  246. WHat should you report when taking Nitro?
    • blurred vision
    • dry mouth
  247. WHy should you watch for nitrate abuse?
    can cause sexual stimulation
  248. are ISOSORBIDE DINITRATE & ISOSORBIDE MONONITRATE fast or slow acting antianginic drugs
    fast acting
  249. What is another name for Isosorbide Dinitrate
  250. Where is Isordil metabolized ?
    in the liver
  251. What is Isordil used for?
    Used for acute angina and for the prophylaxis of
  252. in what forms is Isordil available?
    PO only
  253. What is another name for Iso Mononitrate?
    Imdur, Ismo, Monoket
  254. What is Iso Mononitrate used for?
    •Provides a more steady, therapeutic response than Isordil
  255. How are Ismo and Monoket given?
    2X daily with 7 hours in between doses so as not to build a nitrate tolerance*
  256. What do Beta blockers do for Angina?
    • slows she heart rate and decreases contractility
    • Slows the contractility- decreasing energy needs
  257. WHat are beta blockers used as in Angina?
    1st line drug for stable angina and “effort induced angina”*
  258. What is effert induced angina?
    angina w/ excersion
  259. How do beta blockers effect O2 demand?
    •Decreases O2 demand, therefore increases O2 availability to the myocardium
  260. how can Beta Blockers effect DM pt's
    can increase Blood glucose
  261. What are some common s/e of Beta Blockers r/t hypotension
    • Fatigue
    • lethargy
  262. 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
    • Dizziness,
    • fatigue,
    • lethargy
    • Can cause impotence
    • wheezing
    • dyspnea
  263. Wha pt's should beta blockers and other vasodialaters not be used for?
    • COPD
    • asthma
  264. WHat are some Beta Blockers used for Angina?
    ATENALOL (Tenormin)

    LOPRESSOR (Metoprolol
  265. What is Atenalol used for?
    often used after an MI to decrease death rate
  266. What is IV Atenalol good for?
    Good immediately after an MI because blood flow to GI tract is poor and most are intubated
  267. What forms do Atenalol & Lopressor come in?
    • IV
    • PO
  268. What is Lopressor used for?
    LOPRESSOR (Metoprolol)
  269. 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
  270. What are pt's taking CCB's at high risk for?
    peripheral edema
  271. Why are CCB's used as a 1st line drug for angina?
    Safe with few contraindications
  272. What are some CCB's for angina?
    • NIFEDIPINE (Adalat/Procardia)
    • VERAPAMIL (Calan)
  273. What is CARDIZEM, TIAZAC used for?
    effective oral treatment of angina
  274. in what form is CARDIZEM, TIAZAC available in?
    • IV
    • PO
  275. What did we once have to do NIFEDIPINE (Adalat/Procardia) ?
    puncture the liquid filled capsule and squeeze under the tongue
  276. Why do we no longer squeeze NIFEDIPINE (Adalat/Procardia) under the tongue
    they have decided that this increases the mortality rate
  277. What are some side effects of CCB?
    • Hypotension
    • Brady
    • heart failure
    • Constipation-esp in elderly
    • nausea
    • Rash
    • Peripheral edema-esp pitting edema in extremeties
    • Wheezing
  278. What do you watch for w/ CCB?
  279. WHat are CCB's not used with?
    • Beta blocker-additive effect -both lower Bp
    • Digoxin- can increase dig levels
    • H2 blockers- increases CCB levels
    • Theophyline
    • Lithium
    • ETOH
    • Trycyclic antidepressants
    • Tobacco
  280. What can peripheralvasodilator medications be used for?
    occlusive arterial disease (limited success)
  281. What do peripheralvasodilator medications do?
    Relaxes smooth muscle of peripheral arterial vessels increasing circulation to the extremities
  282. WHat do you see w/ pt's taking peripheralvasodilator medications?
  283. increaed edema
    • swelling to the lower legs and feet
    • often ulcerations below the knees
  284. WHat disease can peripheralvasodilator medications be used to treat?
    treat Raynaud’s disease (vasospasms and thrombophlebitis)
  285. What happens in Raynaud’s disease ?
    no circ to extremeties
  286. When can vasodialater s/e subside
    usually after a few weeks
  287. What kind of medication is Viagra
  288. What do vasodialators cause?
    • hypotension,
    • dizziness,
    • post. Hypotension,
    • HA,
    • dysrythmias,
    • sweating,
    • tingling,
    • but disappear after a few weeks of txt.
  289. What do some vasodialators have in them?
  290. WHat can tartrazine cause?
    allergic reaction with s/s like bronchial asthma
  291. WHat can cause an increased risk to allergies to tartrazine?
    allergies to ASA
  292. in what pt can meds containing tartrazine be contraindicated?
    • those w/ COPD,
    • Asthma
    • other brancoconstriction
  293. 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
  294. 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
  295. How long is IV nitro stable?
    96 hrs
  296. how should all cardiac meds be administered?
    always on a pump

    •Not mixed IV with any other drugs
  297. WHat should pt's be educated to do for all cardiac drugs
    • Decrease caffeine containing foods/drinks,
    • cardiac diet
    • decrease sodium
  298. How should pt's get off of cardiac meds?
    tshould be tapered off
  299. WHen should be checked w/ cardiac meds?
    • Bp before giving meds
    • check electrolytes
  300. What happens to blood vessels secondary for Hypertension?
    Blood vessels decrease in elasticity
  301. what happens to the heart w/ hypertension
    has to work much harder-This causes stress on the heart muscle and vessels, veins and arteries
  302. WHat needs to happen for the HTN treatment to be most effective?
    needs to be identified and treated early in the game
  303. What is normal BP?
    <130 S / <85 D
  304. What is the BP for stage 1 HTN?
    140-159/ 90-99
  305. What is the Bp for stage 2 HTN?
    160-179/ 100-109
  306. What is the Bp for stage 3 HTN?
  307. What is the Bp for stage 4 HTN?
    > or = to 210/> or = to 120
  308. What is the goal of HTN drugs

    • Diastolic below 90
    • decrease damage risks to kidneys,
    • heart
    • brain
  309. WHat are the differant kinds of antihypertensives?
    • Adrenergics
    • Alpha 1 -adrenergic blockers
    • Minipress
    • Regitine
    • Alpha 2- adrenergic receptor stimulators
  310. What are antihypertensive drugs?
    • Clonidine- (Catapres)
    • Methyldopa
    • ACE Inhibitors
    • Lisinopril (Zestril, Prinivil)
    • Captopril (Capoten)
    • Vasotec
    • Angiotensin II Receptor Blockers
  311. What are Adrenergic receptors the target of?
    catacholamines like epi and norepi
  312. What are some of the Adrenergic receptors subtypes?
    Alph 1&2,Beta 1&2
  313. What do Adrenergics do?
    • They inhibit or block stimulation of epi/norepi
    • Decreases BP and heart rate
  314. WHat can adrenergics cause?
    postural and post-exercise hypotension
  315. What can adrenergics be used for?
    • to treat Migraines
    • Can be used for severe dysmennhorea and menopausal
    • flushing
  316. What are some s/e of adrenergics?
  317. Dry mouth
    • Constipation
    • drowsiness, constipation
    • HA
    • Nausea
    • Rash
    • Ortho hypotension
  318. What are some interactons w/ adrenergics?
    • CNS depressants- ETOH, barbituarates, opioids
    • Epi and beta-blockers can increase effect, decreasing BP too much!
  319. What are Alpha 1 -adrenergic blockers?
  320. What do -Alpha 1 -adrenergic blockers do?
    •Block alpha 1 receptors in the arteriesOnly
  321. In what forms are Alpha 1 -adrenergic blockers availables?
    PO only
  322. WHat are some Alpha1 adrenergic blokers for?
    • MInipress
    • Flomax
  323. What does Minipress do?
    • Dilates arterial and venous blood vessels
    • This decreases blood pressure
  324. WHat can Minipress relieve?
    urinary symptoms with BPH
  325. What can Minipress be used w/?
    cardiac glycocides and diuretics fro CHF
  326. What can Minipress cause?
    • severe orthohypotension,
    • but most will develop a tolerance after the first dose
  327. Wha is Regitine used to treat?
    estravasated epi, norepi and dopamine infusion sites
  328. What is Regitine used to Dx?
  329. 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
  330. When are Alpha 2- adrenergic receptor stimulators used
    •This class will be used if all other classes fail
  331. WHat s/e is there a high incidence of w/ Alpha 2- adrenergic receptor stimulators
    • HIGH incidence of severe orthostatic hypotension,
    • fatigue
    • dizziness
  332. WHat are some Alpha 2- adrenergic receptor stimulators drugs
    Clonidine- (Catapres

  333. What does Clonidine- (Catapres) do?
    decreases Bp and can also be used for opioid
  334. What pt's is Clonidine used for?
    used for severe pain in cancer patients
  335. WHat group is Methyldopa drug of choice for?
    pregnent woman
  336. 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
  337. What kind of enzyme is ACE
    Angiotensin-Converting Enzymes
  338. What does ACE inhibiters do?
    mediate extracellular volume and arterial vasoconstriction component of the Bp regulating system

    •They prevent Na+ and H2O reabsorption
  339. What do ACE inhibiters cause?
  340. What is the largest group of antihypertensives
    ACE inhibiters
  341. What are ACE inhibiters used as?
    •Safe first line agent to treat CHF and hypertension
  342. 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.
  343. What is there a risk of with ACE inhibitors?
  344. What do you need to do when giving ACE inhibitors?
    •Monitor k+ levels, and educate about K+ in the diet!
  345. What are some side effects 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
  346. What disease are ACE inhibitors not used in
    renal disease
  347. What are S/S of ACE inhibitor OD?
    Severe hypotension
  348. How do you treat ACE inhibitor OD?
    Give IVF’s to expand the volume and blood volume
  349. What may be required if pt OD of captopril and lisinopril
  350. 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
  351. What is Captopril (Capoten) Commonly used for
  352. 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
  353. for what pt's is Captopril (Capoten)
    •patients in fragile state
  354. What form does Captopril (Capoten ) come in?
    •Only available PO
  355. What kind of diet is recommened for pt taking Lisinopril (Zestril, Prinivil)
    Low Na+ and low K+ diet suggested
  356. What are other names for Lisinopril ?
    • Zestril,
    • Prinivil
  357. What is Lisinopril (Zestril, Prinivil) used for?
    • •Lisinopril is used to improve survival after a heart attack
    • Used to treat CHF
  358. For what group is Lisinopril (Zestril, Prinivil) not used?
    •NOT used in pregnancy
  359. How is Lisinopril (Zestril, Prinivil) used
    used alone or in combination for hypertension
  360. Vasotec
    •Oral an IV preps
  361. Vasotec
    •To be converted into an “active metabolite”- must have proper liver function
  362. What does Vasotec do?
    •Improves survival rates of those post MI
  363. Angiotensin II Receptor Blockers
    -The blockers relax the blood vessels to decrease Bp by decreasing the narrowing effect
  364. 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
  365. 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
  366. 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
  367. 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
  368. Angiotensin II Receptor Blockers
  369. Angiotensin II Receptor Blockers The drugs:

  370. What is Cozaar/Hyzaar (Cozaar with HCT) used for
    used for txt. Of hypertension and CHF•
  371. How does Cozaar compair with ACE inhibitors in CHF?
    May have slightler lower mortality rates than seen with ACE inhibitors in CHF
  372. in what groups is Cozaar contraindicated?

    breast feeding women

    crosses into the milk•
  373. What can Diovan be used with?
    Can be used along with other anytihypertens
  374. What do many antihypertensives come with
    •Many as you see- come with a diuretic in on preparation
  375. What do diureticsin antihypertensives do?
    •These decrease extracellular fluid volumes so there is a decrease in preload which decreases the effort of the heart
  376. 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!
  377. What do PO Minoxidil & Rogaine do?
    decreases Bp
  378. What do topical Minoxidil & Rogaine used for
    • used for hair growth,
    • but can it cause hypotension
    • educate
  379. What do you need to assess for antihypertensives?
    • •Assess liver and kidney function
    • Assess stress
    • Any PVD?
    • Any history or suspect of pheocromocytoma?
  380. 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
  381. What should you watch in pt's w/ antihypertensives?
    •Watch K+
  382. What can you drink with antihypertensives?
    Can take some meds with OJ unless contraindicated
  383. 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!
  384. What assessments do you need to do for antihypertensives?
    • Baseline VS and weight and then along the way
    • QD weights
    • I/O
    • Baseline EKG, telemetry
  385. WHat S/S do you need to check for with antihypertensives?
    • •Watch for syncope
    • Swelling in the feet, ankles, eyes
    • Assess CP and palpitations
  386. What lifestyle changes should pt's on antihypertensives do?
    • Loose weight,
    • avoid stress,
    • exersize safely
    • Watch sodium intake
  387. What can hypokalemia cause?
    •Leg cramps?
  388. What must pt's on antihypertensives be wary of?
    the OTC’s•
  389. What should pt's on antihypertensives do?
    • Change positions slowly
    • Stay hydrated
    • Oral formulas with meals to decrease GI upset
  390. What should pt's on antihypertensives avoid
    smoking or ETOH
  391. What is Hemaetopoesis?
    the process of blood cell formation (RBC's/WBC's & Plateltets)
  392. What is iron used for?
    tissue respiration
  393. What is Iron?
    a O2 carrier in Hgb & myoglobin
  394. What is Iron used in?
    many enzyme reations in the body
  395. Where is iron stored
    • liver,
    • spleen
    • bone marrow
  396. What does Iron deficiency cause?
  397. Who requires the most iron?
  398. What is iron found in?
    found in meat certain veggies grains
  399. How is iron metabolized?
    must be converted by gastric juices before they can be absorbed
  400. What foods help w/ absorption of iron?
    • OJ,
    • veal
    • fish
  401. What foods may impair absorption of iron?
    • eggs,
    • corn
    • beans
    • cereal
  402. What can Iron supplements cause?
    • Nausea
    • stomach upset
    • vomiting
    • diarrhea
    • abd cramping
    • constipation
    • black or red tarry stools
    • can discolor tooth enamel & eyes
    • causes pain upon injection
  403. What is most common in OD death in pedi?

    • iron toxicity
    • enteric coated & resemble candy
  404. 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
  405. At what is iron serum concertration are pt's at serious risk of toxicity?
    300 >ug/dl
  406. What should be done to the stomach for iron OD?
    • stomach should be emptied via ipecac syrup or lavage
    • whole gut lavage
  407. What does severe toxicity cause?
    What should be done?

    chelation therapy w/ deferoxamine should be initiated(ring shaped molecules that bind to metal)
  408. When is iron absorption enhanced?
    when given w/ absorbic acid
  409. When is iron absorption reduced
    when taking antacids
  410. What meds does iron reduce the effects of?
    • thyroid
    • tetracycline
    • quinolones (antibiotics)
  411. What are some iron supplements?
    • ferrous fumarate (feostat, Hemocyte)
    • Iron Dextran (INFeD)
  412. What are Ferrous Furnarates
    iron salts
  413. What do Ferrous Furmarate contain?
    the highest amount of iron per gram of salt consumed
  414. What is Iron Dextran?
    Colloid solution of iron and dextran
  415. What is Iron Dextran used for?
    iron deficiency Anemia
  416. How is Iron Dextran administered?
    IM & IV
  417. What does Iron Dextran have a low incidence of ?
  418. 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
  419. What is folic acid?
    water soluble B compelx vit
  420. What does Folic acid help prevent in pregnency?
    • neural tube defects
    • such as spina bifida, encephaly & enecphalocele
  421. When is it best to take folic acid for earliest ability in pregnancy?
    at least one month before pregnanay
  422. What is Folic Acid the primary treatment for?
    megaloblastic anemia-resulting from folic acid deficiency
  423. what kind of intake of folic acid does the body require?
  424. WHat are some foods with folic acid
    • dried beans,
    • peas,
    • oranges
    • green veggies
  425. What is Questran
    a bile acid blocker
  426. what are s/e of zetia
    • diarrhea, back pain, and abdominal pain.
    • works spec on GI tract
  427. What is the main goal of dyslipidemic therapy
    LDL <100

    raise HDL lower LDL
  428. What is Niacin used for in dyslipidemic therapy?
    borderline high lipidemia

    can help reduce lipid
  429. What are S/e of niacin

    usually stops after 2 days

    blut w/ ASA 45 min prior if not contraindicated
  430. What do you monitor in dyslipidemic therapy?
    • Vit D
    • esp in elderly women

    many meds fight w/ vit D
  431. what do blood forming agents do?
    help raise blood cells

    often given to CA pt
  432. S/e of blood forming agents
    • gi stuff
    • constipation
  433. what are other blood forming agents?
    • vit b12
    • erythropoieten (procrit, epogen)
  434. What is folic acid incompatible with
    • calc
    • iron sulf
    • vit b complex
    • vit c in same solution
  435. how should liq iron be given
    • through straw
    • no teeth discolor
  436. how should IM iron be givn

    it is thick
  437. what is needed on hand for iron dextran IV
    emer equip
  438. what should pt's taking b12 eath
    • diet high in b12
    • fish oysters egg yolk
    • organ meet
    • dairy
    • clams
Card Set:
Pharm IV
2012-04-20 20:47:49

Heart Failure
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