Cardiovascular

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Author:
Christyna
ID:
45312
Filename:
Cardiovascular
Updated:
2010-10-26 22:14:56
Tags:
pharm
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Description:
meds
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  1. Meds
    • Mechanical (inotropic +/-): contration *hard or relax heart*
    • Electrical (chronotropic (+/-): timing/HR
    • dromotropic (+/-)-conduction of impulses
  2. cardiac
    • automaticity-heart on table still able to beat
    • conductivity-conducts impulses in an orderly fashion
    • refactory-heart must finish impulse (beat) can't do the next one til done
  3. normal conduction pathway
    SA node->AV node->Bundle of His->R&L Bundle Branches->Purkinje Fibers
  4. depolarization (STIMULATED)
    • inside positive
    • action potential & conduction are electrolyte dependent esp. Na, K, Ca, and Mg
  5. Repolarization (RESTING)
    inside negative
  6. SNS
    • promotes impulse formation & conduction
    • increases rate & contractility
    • vasodilates coronary arteries
    • vasoconstricts peripheral arteries except skeletal
    • +chronotropic, +inotropic, +dromotropic
  7. PNS
    • inhibits impulse formation & conduction
    • decreases HR
    • vasoconstricts coronary arteries
  8. Antidysrthmics or Antiarrhythmics
    drugs used to diminish rhythm disturbances & hopefully achieve normal sinus rhythm
  9. Vaughan Williams Classification
    • Class 1: used for ventricular tachyarrhythmias
    • Class 2: slows HR
    • Class 3: amiodarone (Cordarone) #1 drug of choice in most tachyarrhythmias. SE: bluish discoloration
    • Class 4: reduces SA, delays AV, and reduces contractility
  10. adenosine (Adenocard)
    • 10 sec. half-life, warn pt HR will go down quickly
    • pt may feel bad for a few min.
    • requires very rapid IV straight push (<3 sec.)
  11. Cardiac glycoside
    • digoxin (Lanoxin): used primarily to treat HF
    • (+ inotropic)-increases contractility
    • (- chronotropic)
    • (- dromotropic)
    • long half-life
    • maintenance therapy: 0.125 mg recommended PO daily
  12. Nursing for antiarrhythmics
    • almost all drugs can cause "proarrhythmic" (dysrhythmia) esp. heart block
    • check HR before and after med. admin.
    • SE: of most is hypotension
    • check BP
    • instruct slow position changes
  13. CHF
    • impaired emptying resulting in inadequate CO
    • heart "remodels" itself-->ventricles dilate & hypertrophy
    • s/sx: decreased tissue perfusion & volume overload; edema; dyspnea
    • "rubber band is over stretched"
  14. definitions
    • preload-left ventricle diastolic volume (volume of blood in heart)
    • afterload- resistance of heartload (how constricted or dilated vessles are)
  15. meds for CHF
    • + inotropic agents such as cardiac glycosides (Digoxin) to improve contractility
    • (decrease preload)
  16. meds for CHF (2)
    ACEIs and ARBs decrease vasoconstrictive effect of angiotensin (decrease afterload); dilate veins; and decrease aldosterone (decrease preload)
  17. meds for CHF (3)
    • diuretics to decrease volume and decrease preload
    • vasodilators to decrease resistance (decrease afterload &/or decrease venous return) and decrease preload
    • beta blockers (- inotropic) to decrease myocardial workload
  18. digoxin continued
    • SE: anorexia, heart block, yellow/green halos
    • ANTIDOTE: Digibinde. rarely used
    • apical pulse must be taken for 1 min. withhold if <60bpm
    • check if dig level is ordered- >2 then withhold
    • check electrolye levels
    • milk and bran may interfere w/ absorption
    • Therapeutic Level: 0.5-2.0 ng (nanograms)/mL
  19. beta blockers
    • commonly used to reduce workload of heart
    • not given if showing s/sx of acute heart failure
  20. Natrecor
    • natural (synthetic) form of BNP
    • decrease in afterload and preload
    • improvement in CO
  21. angina
    • result of myocardial ischemia: most commonly secondary to coronary artery disease secondary to athlerosclerosis.
    • stable angina relieved by rest and/or nitrates
    • unstable angina-not relievved by rest or nitrates (<--RED FLAG-headed for MI)
  22. supply and demand
    • Angina: Decreased supply, ^ in demand
    • Drug therapy: ^ supply, decreases demand
  23. SE of all antianginal meds
    • hypotension
    • check BP & teach slow position changes
  24. Nitrates (nitroglycerin
    • increases supply (oxygen) & decreases demand
    • vasodilators (decrease preload) & decreases afterload
    • headache diminishes over time
  25. Nitroglycerin tabs
    • 1 tab-if pain goes away, notify physician
    • 1 tab-if pain lessens but still there, take 2nd, 3rd if needed (5 min. apart)
    • 1 tab-if pain doesn't lessen call 911! take 2nd while waiting for EMS & 3rd if needed
  26. NTG
    • topical in cream or patch. apply in same general area
    • not recommended at night
    • NTG sublingual tab or spray
  27. calcium channel blockers
    • improve supply and decrease demand
    • vasodilate
  28. beta blockers
    • decrease demand
    • SE: hypotension
    • (-) inotropic effect
    • (-) chronotropic effect
  29. clopidogrel (Plavix)
    • antiplatelet med that's given to pt w/ unstable angina
    • used for cath. pts
  30. athlerosclerosis & antilipid med
    • reduces cholesterol levels, LDLs, and triglycerides
    • ^ HDLs
  31. antilipid meds
    • "statin" family
    • block enzymes needed to make cholesterol
    • helps stabalize the plaque that is already there
    • SE: hepatotoxic-monitor liver function
    • myostits-muscle weakness, muscle cramps. taken in evening
  32. bile acid sequestrant
    • decreases synthesis of cholesterol
    • settle powder before mixing
    • vitamin K not absorbed
  33. fibric acid derivatives (fibrates)
    • decrease triglycerids & ^ HDLs
    • SE: hepatotoxicity
  34. Niacin/ Nicotonic acid
    SE: extreme itching & vasodilation
  35. Peripheral arterial disease
    • risk for MI & stroke
    • meds used for claudication (leg pain)
  36. peripheral venous disease (DVT)
    anticoagulants to prevent & treat

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