Prototype ACE inhibitor
captopril
Protoype Beta blocker
Atenolol
Prototype of ARBs
Losartan
Prototype ca channel blocker
Nifedipine
prototype Alpha2 blocker
Clonidine
Prototype Alpha/Beta blocker
Carvedilol
Prototype HMG-CoA Reductase Inhibitor
Atorvastatin
Afterload
the pressure that the heart must work against to eject blood during vent. Contraction.
Proportional to the average arterial pressure
The force or load against which the heart has to contract to eject blood
Preload
The initial stretching of the cardiac myocytes prior to contraction
Ventricular filling
Bp Meds: What qualities/conditions would trigger increased monitoring by the nurse?
-Women wishing to become pregnant
-Decreased renal function
-Hypotension
Beta Blockers: What conditions would require careful monitoring?
Atenolol
Heart failure,
sinus bradycardia, PVD, renal and liver disorders, myasthenia graves, diabetes, depression
Alpha/beta blocker: contraindication
Know which conditions and/or nursing assessments are contraindicated
Carvedilol
Asthma, Unstable heart failure, heart block, bradycardia
Caution: diabetic and children
calcium channel blocker: adverse effects
Nifedipine
Medication lowers BP & Hr so monitor before administering
-Dependent edema
Reflex tachycardia, orthostatic hypotension, peripheral edema, arrhythmias
ACE inhibitor indications
captopril
Hypertension
Heart failure (HF)
Diabetic nephropathy
Angiotensin receptor blocker: action
Losartan
Blocks angiotensin II receptors
Doesn't allow vasoconstriction
atorvastatin: adverse effects
Myopathy- muscle pain, and breakdown (rhabdomyolysis)
Hepatic toxicity
atorvastatin: contraindications
-teratogenic
-warfarin
-grapefruit juice
-myopathy
-hepatotoxicity
atorvastatin: education
-Report muscle plain and monitor ck levels (myopathy)
-Report s/s of hepatic toxicity- abdominal pain, fatigue, anorexia, jaundice, and loss of appetite.
-prevents the synthesis of cholesterol by the liver, occurs overnight (restorative phase) take medica
atorvastatin: interactions
-Warfarin
-Grapefruit juice
-Concurrent use of a fibrate or other drug to lower cholesterol can increase risk for myopathy or liver toxicity
fibrates: interactions
Know medication interactions
-Statin antilipemics greatly increase risk for myopathy -Warfarin with fibrates increases risk for bleeding
nitrates: action
After absorption, nitrate turns to nitric oxide w/ help from sulfydryl
Dilation of vascular smooth muscle of primarily the coronary veins and arteries
At the same time, venous dilation of the veins that feed the heart
nitroglycerin: short acting administration
Spray, sublingual
nitroglycerin: topical administration
Hairless, clean skin. Site needs to be rotated. Cream is ordered by inches. Squeeze on paper to measure. Nitroglycerin holiday (12 on 12 off) to reduce incident of tolerance.
nitroglycerin: routes of administration
IV, oral, topical, sublingual, and spray.
nitroglycerin: education
Know the route
Take at the first instance of pain (call 911), wait 5 mins, take another. Wait 5 mins. Take third dose.
Hypotension, tachycardia, headaches.
antiarrhythmics: assessment
Monitor VS and ECG rhythm continuously
class III: action/prototype
Class III: Potassium Blockers (Amiodarone)
Block K channel and affect Na and Ca channel
Block beta adrenergic receptors
Slows down automaticity
Lowers contractility and dilates coronary and peripheral blood vessels
Widened QRS and PR and QT
class III: administration
Potassium blocker (Amiodarone)
Start in hospital for EKG monitoring until stable
Correct electrolyte imbalance beforeing initiation
If IV large bore line
Monitor EKG, HR, BP
class Ia: adverse effects
Sodium Channel Blockers (Quinidine/procainamide)
Emboli- Arterial embolism may be mobilized. Blood thinners indicated if treating A-fib. Increase levels of warfarin (increase risk of bleeding). Bleeding precautions, adjusted dose.
Class II: contraindications
Beta blockers (propranolol)
Bradycardia, heart block, pulmonary edema, cardiogenic shock
Caution: hyperthyriod, diabetes
diuretics: Which dietary education is important to include?
Potassium rich foods: beans, prunes, raisins, tomato, spinach, baked potato
thiazide: education
Monitor blood glucose levels, Be aware that this effect may occur; usually without symptoms
Monitor for gout symptoms, especially with previous history.
Eat potassium rich food
digoxin: risk factors
What electrolyte imbalance is important to monitor?
Potassium, calcium, magnesium
digoxin: contraindications
Uncontrolled Ventricular dysrhythmias
AV block or severe heart disease
Digoxin toxicity
milrinone: administration
Available for IV infusion only
Give a loading dose over 10 minutes and then administer a dose based on client's weight by continuous infusion
Some solution incompatibilities exist; use dedicated IV line if possible
digoxin: s/s toxicity
Nausea/vomiting
Anorexia
Vision changes: blurry, double, or yellow/green halos
digoxin: action
Inhibits sodium-potassium pump
Helps the heart pump more efficiently
Inhibits normal function of Na/K pump
Positive inotrope: harder contractility
Negative chronotropic: slower heart rate
Negative dromotropic: slower SA/VA node impulse
Squeeze more blood
Digoxin antidote
Digibind
spironolactone: education
Hyperkalemia- palpitations, irregular heart rate. Monitor labs.
Avoid potassium supplements, salt substitutes, foods
Menstrual irregularities and other hormonal charges
furosemide: interventions
What are nursing considerations when monitoring labs for a patient on furosemide?
Check electrolytes before administer medication; chemistry pannels (potassium and sodium)
Glucose levels
Monitor uric acid levels
furosemide: adverse effects
Ototoxicity
Electrolyte imbalance
Hyperglycemia
Increase uric acid levels
furosemide: indications
When would furosemide be favored over other diuretics?
Treats pulmonary edema in heart failure
thiazides: contraindications
Allergy to sulfa
Anuria- produce urine
End stage renal failure
etanercept: administration
Which assessments are important before starting etanercept?
(RA)
Weekly SQ
TB test prior to medication- ensure negative test before medication. Check routinely through treatment
methotrexate: interactions
(ra)
NSAIDS, sulfa, and warfarin increase bleeding
raloxifene: education
(osteoporosis)
Adequate calcium intake, vitamin D, and weight-bearing exercise
DO NOT TAKE WITH HORMONAL REPLACEMENT THERAPY
Monitor for DVT symptoms
Ensure bone density scans regularly
raloxifene: adverse effects
Increase risk of DVTs
raloxifene: evaluating outcomes
Bone density scans/ prevention of bone loss
bisphosphates: education
Report changes in swallowing
Remain upright after taking
Wait 30 minute before dairy, calcium intake
Osteo-necrosis jaw pain/ muscle joint pain
bisphosphonates: administration
Know the timing, patient positioning, interactions with other meds/dietary intake
Wait 30 minute for dairy, calcium supplements
Remain upright 30 minutes
Give with full glass of water
bisphosphates: adverse effects
Erosive esophagitis
calcitonin: adverse effects
Hypocalcemia (s/s muscle spasms/tingling)
calcium carbonate: administration
Chew tablets, drink a full glass of water
finasteride: action
Inhibits 5-alpha reductase, which reduces testosterone and reverse prostatic overgrowth
finasteride: indications
Benign prostatic hypertrophy (males only)
finasteride: evaluating outcomes
Serum PSA level decrease
tamsulosin: indications
Benign prostatic hypertrophy
tamsulosin: education
Report unrelieved headaches due to hypotension
Therapy is life long
Expected adverse effects: retrograde ejaculation
Contraindicated with sildenafil
testosterone: contraindications
Prostate cancer
Prostatic hyperplasia, obstruction
bethanechol: contraindications
Hypotension
COPD, asthma
GI/GU obstruction
oxybutynin: contraindications
Angle glaucoma, GI/GU obstruction
Class 1A, 1B, 1C
Sodium channel blockers
Controls rhythm
1A- Quinidine, Procainamide
1B- Lidocaine
1C- Flecaininde
Class II
Beta-adrenergic blockers
Controls rate
Propranolol
Class III
Potassium channel blockers
Controls rate and rhythm
Class IV
calcium channel blockers
Controls rate
Verapamil