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?
What reactions should be reported b pt's taking antidysrhytmics?
Any increased cough,
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?
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)
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?
inadequate cerebral perfusion,
pericardial tamponade (fluid accumulation in the heart causing increased pressure),
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?
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
What should you do if pt gets postural hypotension from Nitrates/Nitrites?
assess laying, sitting and standing
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?
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?
take 3rd dose
how long should SL Nitroglycerin pt's wait b/w doses if having CP
How should nitroglycerine be stored?
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?
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?
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
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?
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,
WHat do you asses for cardiac meds?
•Assess and list all other drugs
Medical and surgical Hx
Caution with head injuries
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
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,
How should pt's get off of cardiac meds?
tshould be tapered off
WHen should be checked w/ cardiac meds?
Bp before giving meds
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?
Lisinopril (Zestril, Prinivil)
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?
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?
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?
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
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
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?
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
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
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?
black or red tarry stools
can discolor tooth enamel & eyes
causes pain upon injection
What is most common in OD death in pedi?
enteric coated & resemble candy
What is treatment of iron OD?
symptomatic treatment & supportive measures
MAINTAIN the airway
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?
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?