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

    increased organ hypofusion & dysfunction
  22. WHat causes increased organ hypoperfusion & dysfunction?
    constricted arterioles
  23. What is preload?
    • diastolic ventricular filling pressure
    • amount of venous blood returning to the heart
  24. What does angiotensin II do?
    • stimulating aldosterone release from adrenal cortex &
    • vasopressin (antidiuretic hormone) from posterior pituitary
  25. these promotes sodium & water retention
  26. What is afterload?
    amount of resistance in the aorta peripheral blood vessels that the heart must overcome to pump effectively
  27. What are the main S/S of HF
    dyspnea & fatigue --> exercise intolerance & fluid retention--> pulmonary congestion & peripheral edema
  28. WHat is compensated HF
  29. 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
  30. what causes edema & jugular vein distention?
    congestion of veins & leakage of fluid into tissues
  31. what is S/S of acute, severe cardiac decompensation?
    pulmonary edema (req immediate treatment)
  32. What are HF drugs for
    • to try to improve circulation
    • alter compensatory mechanis
    • reverse heart damage
  33. what is the only commonly used digitalis glycoside?
    Digoxin (lanoxin)
  34. What are antidysrhythmic agents used for
    prevention and treatment of cardiac dysrhythmia
  35. when do dysrhythmias become a problem?
    when they interfere with cardiac function & the ability to perfuse body tissues
  36. What is automaticity of the heart?
    the heart's ability to generate an electrical impulse

    electrical impulse formation
  37. what is exitability of the heart?
    the ability of cardiac muscle cell to respond to electrical stimulus
  38. What is conductivity?
    ability of cardiac tissue to transmit electrical impulses
  39. What is dysrhythmia?
    any disturbance or abnormality in the normal cardiac rhythm
  40. - feels as a skipped beat
  41. when are dysrhythmias clinically significant?
    when the interfere with cardiac function
  42. What do antidysrhythmic drugs do?
    alter the heart's electrical conduction system
  43. How are antidysrhythmic drugs usually classified
    • according to their mechanisms of action
    • effects on conduction system
  44. What is the goal of antidysrhythmic drug therapy?
    • to prevent/relieve symptoms
    • prolong survival
  45. What do drugs for rapid dysrhythmia do
    • reduce automaticity
    • slow conduction of electrical impulses through heart
    • prolong refactory period of myocardial cells
  46. What are some Class I (Sodium Channel Blockers (membrane stablizers) antidysrhythmics?
    • Norpace
    • Procanamide
    • Quinidine
    • Lidocaine
  47. What are Class I antidysrhythmic drugs?
    Sodium Channel Blockers (membrane stablizers)
  48. How do Class I antidysrhythmic drugs work?
    interferes with the sodium channels and stabilizes the hearts excitability
  49. 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
  50. What does Quinidine do?
    • reduces automaticity
    • slows conduction
    • prolongs refractory period
  51. What does Quinidine do to electrical impulses?
    accelerate their rate
  52. 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
  53. What is thrombocytopenic pupura (TTP)
  54. 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
  55. Wher is Quinidine metablized and excreted?
    • metab: liver
    • excreted: urine
  56. What are the theraputic levels of Quinidine?
    2-5 mcg/mL
  57. What are toxic serum levels of Quinidine?
    > 5 mcg/mL
  58. in what pts is quinidine contraindicated?
    • severe, uncompensated HF
    • w/ heart block
  59. What is procainamide used for?
    atrial and ventricular tachy-dysrhythmias
  60. What is procainamide most effective for?
    • suppressing premature Vent contractions
    • preventing the recurrence of V tach
  61. What can procainamide cause
    high incidence of adverse effects
  62. lupus-like syndrome
    • n/v/d- anorexia
    • fever,
    • leucopenia,
    • maculopapular rash,
    • itching/flushing
  63. In what pts is procainamide contraindicated
    • Lupus,
    • complete heart block,
    • 2nd and 3rd degree heart block
  64. What are theraputic serum levels of procainamide?
    4-8 mcg/mL
  65. What is Disopyramide known as?
  66. What is Norpace used for?
    adults w/ life-threatening ventricular tachydysrhthmias
  67. What are the toxic serum levels of Norpace?
    > 8mcg/mL
  68. What are the theraputic levels of Norpace?
    2-8 mcg/mL
  69. Where is Norpace excreted?
    kidneys & liver in almost equal proportion
  70. What does norpace cause?
    • wider QRS
    • hypotension
  71. What kind of side effects can norpace have?
    • prodysrhthmiic
    • anti-cholinergic
  72. in what pts is norpace contraindicated?
    with poor left vent function
  73. How does the incidence of lupus w/ norpace compare to procanamide
    less than that of Procanamide
  74. What are class II antidysrhythmic drugs?
    beta blockers
  75. What kind of beta blockers are there?
    • selective (1)
    • nonselective (1&2)
  76. 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
  77. What kind of dysrhythmia are ClassII effective against?
    dysrhythmia from excessive sympathetic activit
  78. What are Class II (Beta blockers) antidysrhythmics most often used for?
    to slow the ventricular rate of contraction in atrial flutter & a-fib
  79. 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
  80. When are Beta Blockers especailly beneficial ?

    after an MI

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

    What are other signs

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

    assess closely for Bradycardia

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

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

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

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

    4 hours apart from other antidysrhythmics

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

    digoxin toxicity

    may worsen heart block
  178. What does Verapmil precipitate with?
    •Precipitates with Nafcillin and Sodium Bicarb
  179. what drug should not be put into the same IV asVerapmil?
    beta blockers
  180. What are Nitratesoften taken with
    often taken WITH Calcium Channel Blockers
  181. Why do you need to be careful when giving Antidysrhythmics to elderly?
    increased side effects- weakness and dizziness (safety)
  182. What can nicotine do to Antidysrhythmics?
    decrease effectiveness
  183. What effects can ETOH have on antidysrhythmic drugs?
    increase hypotensive episodes
  184. What happens if you abruptly stop taking antidysrhythmic?
    can have a rebound effect
  185. 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
  186. What is Heart Block?
    A heart block can be a blockage at any level of the electrical conduction system of the heart
  187. 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
  188. What should be done when giving antidysrhythmics?
    • Initial EKG and VS
    • monitor these closely throughout course
  189. What should be done with IV antidysrhythmics?
    have on pump
  190. What kind of monitored should pt's on IV antidysrhythmics be on?
    continous cardiac monitor
  191. What are some adverse reactions you should watch for w/ pt's on antidysrhythmic drugs?
    • heart block
    • dysrhythmias
    • hypotensioin
  192. What reactions should be reported b pt's taking antidysrhytmics?
    • Any increased cough,
    • SOB,
    • weight gain
  193. How is Lidocaine administered
  194. How does Lidocaine work?
    It increase the electricalimpulses and weak impulses are weeded out
  195. What does lidocaine do?
    it slows the heart rate overall
  196. What do you asses for when giving lidocaine?
    • tinitus,
    • blurred vision,
    • HA/dizziness,
    • seizures,
    • hallucinations
  197. What kind of antidysrhythmic drug is Adenosine?
  198. What is Adenosine given for?
  199. Whatdoes adenosine cause?
    several seconds of asyystole when cardioverting tach to NSR
  200. anxiety
  201. What is cardioverting?
    converting abnormally fast heart rate or cardiac arrhythmia to a normal rhythm
  202. how should Adenosine be given?
    by rapid bolus injection

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

    safety is an issue
  233. WHat is the 1/2 life of Nitrates/Nitrites?
    1-4 minutes- readily absorbed
  234. WHat are s/s of postural hypotension?
    • flushing,
    • dizziness,
    • sweating,
    • syncope
  235. in what pt's is the safety of taking Nitrates/Nitrites still being investigated?
    with acute MI
  236. in what pt's is Nitrates/Nitrites transdermal patch showing good performance?
    recent MI
  237. How often do you need to renew Nitro Rx?
    every 3 mo-loses strength
  238. What does Nitro cause?
    a throbbing headache- it is a potent medication
  239. What can you take for HA cause by Nitro?
  240. What substinces when taken w/ Nitrates/Nitrites cause severe hypotension?
    • ETOH
    • beta blockers,
    • narcotics,
    • antihypertensives,
    • vasodilators
  241. How should you take po nitro
    on an empty stomach
  242. What does Tobacco use do to nitrates?
    reduces effects
  243. What does Nitroglycerin do to VMA lab levels?
    increases VMA (vanillylmandelic acid) levels (end stage metabolite of epi and norepi)
  244. What is SL Nitroglycerin used for?
    for CP- ASAP
  245. What do you need to educate pt to do w/ SL Nitroglycerin?
    •Educate to keep on their person at all times
  246. What should SL Nitroglycerin pt's do if they feel CP?
    lay down w/ feet up take dose
  247. 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
  248. how long should SL Nitroglycerin pt's wait b/w doses if having CP
    3-5 min
  249. 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
  250. What is needed when giving IV Nitro?
    ICU monitoring
  251. WHat should you report when taking Nitro?
    • blurred vision
    • dry mouth
  252. WHy should you watch for nitrate abuse?
    can cause sexual stimulation
  253. are ISOSORBIDE DINITRATE & ISOSORBIDE MONONITRATE fast or slow acting antianginic drugs
    fast acting
  254. What is another name for Isosorbide Dinitrate
  255. Where is Isordil metabolized ?
    in the liver
  256. What is Isordil used for?
    Used for acute angina and for the prophylaxis of
  257. in what forms is Isordil available?
    PO only
  258. What is another name for Iso Mononitrate?
    Imdur, Ismo, Monoket
  259. What is Iso Mononitrate used for?
    •Provides a more steady, therapeutic response than Isordil
  260. How are Ismo and Monoket given?
    2X daily with 7 hours in between doses so as not to build a nitrate tolerance*
  261. What do Beta blockers do for Angina?
    • slows she heart rate and decreases contractility
    • Slows the contractility- decreasing energy needs
  262. WHat are beta blockers used as in Angina?
    1st line drug for stable angina and “effort induced angina”*
  263. What is effert induced angina?
    angina w/ excersion
  264. How do beta blockers effect O2 demand?
    •Decreases O2 demand, therefore increases O2 availability to the myocardium
  265. how can Beta Blockers effect DM pt's
    can increase Blood glucose
  266. What are some common s/e of Beta Blockers r/t hypotension
    • Fatigue
    • lethargy
  267. 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
  268. Wha pt's should beta blockers and other vasodialaters not be used for?
    • COPD
    • asthma
  269. WHat are some Beta Blockers used for Angina?
    ATENALOL (Tenormin)
  270. LOPRESSOR (Metoprolol
  271. What is Atenalol used for?
    often used after an MI to decrease death rate
  272. What is IV Atenalol good for?
    Good immediately after an MI because blood flow to GI tract is poor and most are intubated
  273. What forms do Atenalol & Lopressor come in?
    • IV
    • PO
  274. What is Lopressor used for?
    LOPRESSOR (Metoprolol)
  275. 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
  276. What are pt's taking CCB's at high risk for?
    peripheral edema
  277. Why are CCB's used as a 1st line drug for angina?
    Safe with few contraindications
  278. What are some CCB's for angina?
    • NIFEDIPINE (Adalat/Procardia)
    • VERAPAMIL (Calan)
  279. What is CARDIZEM, TIAZAC used for?
    effective oral treatment of angina
  280. in what form is CARDIZEM, TIAZAC available in?
    • IV
    • PO
  281. What did we once have to do NIFEDIPINE (Adalat/Procardia) ?
    puncture the liquid filled capsule and squeeze under the tongue
  282. Why do we no longer squeeze NIFEDIPINE (Adalat/Procardia) under the tongue
    they have decided that this increases the mortality rate
  283. 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
  284. What do you watch for w/ CCB?
  285. 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
  286. What can peripheralvasodilator medications be used for?
    occlusive arterial disease (limited success)
  287. What do peripheralvasodilator medications do?
    Relaxes smooth muscle of peripheral arterial vessels increasing circulation to the extremities
  288. WHat do you see w/ pt's taking peripheralvasodilator medications?
  289. increaed edema
    • swelling to the lower legs and feet
    • often ulcerations below the knees
  290. WHat disease can peripheralvasodilator medications be used to treat?
    treat Raynaud’s disease (vasospasms and thrombophlebitis)
  291. What happens in Raynaud’s disease ?
    no circ to extremeties
  292. When can vasodialater s/e subside
    usually after a few weeks
  293. What kind of medication is Viagra
  294. What do vasodialators cause?
    • hypotension,
    • dizziness,
    • post. Hypotension,
    • HA,
    • dysrythmias,
    • sweating,
    • tingling,
    • but disappear after a few weeks of txt.
  295. What do some vasodialators have in them?
  296. WHat can tartrazine cause?
    allergic reaction with s/s like bronchial asthma
  297. WHat can cause an increased risk to allergies to tartrazine?
    allergies to ASA
  298. in what pt can meds containing tartrazine be contraindicated?
    • those w/ COPD,
    • Asthma
    • other brancoconstriction
  299. 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
  300. 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
  301. How long is IV nitro stable?
    96 hrs
  302. how should all cardiac meds be administered?
    always on a pump

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

    • Diastolic below 90
    • decrease damage risks to kidneys,
    • heart
    • brain
  315. WHat are the differant kinds of antihypertensives?
    • Adrenergics
    • Alpha 1 -adrenergic blockers
    • Minipress
    • Regitine
    • Alpha 2- adrenergic receptor stimulators
  316. What are antihypertensive drugs?
    • Clonidine- (Catapres)
    • Methyldopa
    • ACE Inhibitors
    • Lisinopril (Zestril, Prinivil)
    • Captopril (Capoten)
    • Vasotec
    • Angiotensin II Receptor Blockers
  317. What are Adrenergic receptors the target of?
    catacholamines like epi and norepi
  318. What are some of the Adrenergic receptors subtypes?
    Alph 1&2,Beta 1&2
  319. What do Adrenergics do?
    • They inhibit or block stimulation of epi/norepi
    • Decreases BP and heart rate
  320. WHat can adrenergics cause?
    postural and post-exercise hypotension
  321. What can adrenergics be used for?
    • to treat Migraines
    • Can be used for severe dysmennhorea and menopausal
    • flushing
  322. What are some s/e of adrenergics?
  323. Dry mouth
    • Constipation
    • drowsiness, constipation
    • HA
    • Nausea
    • Rash
    • Ortho hypotension
  324. What are some interactons w/ adrenergics?
    • CNS depressants- ETOH, barbituarates, opioids
    • Epi and beta-blockers can increase effect, decreasing BP too much!
  325. What are Alpha 1 -adrenergic blockers?
  326. What do -Alpha 1 -adrenergic blockers do?
    •Block alpha 1 receptors in the arteriesOnly
  327. In what forms are Alpha 1 -adrenergic blockers availables?
    PO only
  328. WHat are some Alpha1 adrenergic blokers for?
    • MInipress
    • Flomax
  329. What does Minipress do?
    • Dilates arterial and venous blood vessels
    • This decreases blood pressure
  330. WHat can Minipress relieve?
    urinary symptoms with BPH
  331. What can Minipress be used w/?
    cardiac glycocides and diuretics fro CHF
  332. What can Minipress cause?
    • severe orthohypotension,
    • but most will develop a tolerance after the first dose
  333. Wha is Regitine used to treat?
    estravasated epi, norepi and dopamine infusion sites
  334. What is Regitine used to Dx?
  335. 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
  336. When are Alpha 2- adrenergic receptor stimulators used
    •This class will be used if all other classes fail
  337. WHat s/e is there a high incidence of w/ Alpha 2- adrenergic receptor stimulators
    • HIGH incidence of severe orthostatic hypotension,
    • fatigue
    • dizziness
  338. WHat are some Alpha 2- adrenergic receptor stimulators drugs
    Clonidine- (Catapres

  339. What does Clonidine- (Catapres) do?
    decreases Bp and can also be used for opioid
  340. What pt's is Clonidine used for?
    used for severe pain in cancer patients
  341. WHat group is Methyldopa drug of choice for?
    pregnent woman
  342. 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
  343. What kind of enzyme is ACE
    Angiotensin-Converting Enzymes
  344. What does ACE inhibiters do?
    mediate extracellular volume and arterial vasoconstriction component of the Bp regulating system

    •They prevent Na+ and H2O reabsorption
  345. What do ACE inhibiters cause?
  346. What is the largest group of antihypertensives
    ACE inhibiters
  347. What are ACE inhibiters used as?
    •Safe first line agent to treat CHF and hypertension
  348. 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.
  349. What is there a risk of with ACE inhibitors?
  350. What do you need to do when giving ACE inhibitors?
    •Monitor k+ levels, and educate about K+ in the diet!
  351. 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
  352. What disease are ACE inhibitors not used in
    renal disease
  353. What are S/S of ACE inhibitor OD?
    Severe hypotension
  354. How do you treat ACE inhibitor OD?
    Give IVF’s to expand the volume and blood volume
  355. What may be required if pt OD of captopril and lisinopril
  356. What can you not give w. ace inhitibitrs
    •Do not give with ASA, NSAIDS, K+ sparing diuretics or K+ supplements
  357. No lithium b/c it increases lithium levels
  358. What is Captopril (Capoten) Commonly used for
  359. 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
  360. for what pt's is Captopril (Capoten)
    •patients in fragile state
  361. What form does Captopril (Capoten ) come in?
    •Only available PO
  362. What kind of diet is recommened for pt taking Lisinopril (Zestril, Prinivil)
    Low Na+ and low K+ diet suggested
  363. What are other names for Lisinopril ?
    • Zestril,
    • Prinivil
  364. What is Lisinopril (Zestril, Prinivil) used for?
    • •Lisinopril is used to improve survival after a heart attack
    • Used to treat CHF
  365. For what group is Lisinopril (Zestril, Prinivil) not used?
    •NOT used in pregnancy
  366. How is Lisinopril (Zestril, Prinivil) used
    used alone or in combination for hypertension
  367. Vasotec
    •Oral an IV preps
  368. Vasotec
    •To be converted into an “active metabolite”- must have proper liver function
  369. What does Vasotec do?
    •Improves survival rates of those post MI
  370. Angiotensin II Receptor Blockers
    -The blockers relax the blood vessels to decrease Bp by decreasing the narrowing effect
  371. 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
  372. 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
  373. 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
  374. 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
  375. Angiotensin II Receptor Blockers
  376. Angiotensin II Receptor Blockers The drugs:

  377. What is Cozaar/Hyzaar (Cozaar with HCT) used for
    used for txt. Of hypertension and CHF•
  378. How does Cozaar compair with ACE inhibitors in CHF?
  379. in what groups is Cozaar contraindicated?

    breast feeding women

    crosses into the milk•
  380. What can Diovan be used with?
    Can be used along with other anytihypertens
  381. What do many antihypertensives come with
    •Many as you see- come with a diuretic in on preparation
  382. What do diureticsin antihypertensives do?
    •These decrease extracellular fluid volumes so there is a decrease in preload which decreases the effort of the heart
  383. 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!
  384. What do PO Minoxidil & Rogaine do?
    decreases Bp
  385. What do topical Minoxidil & Rogaine used for
    • used for hair growth,
    • but can it cause hypotension
    • educate
  386. What do you need to assess for antihypertensives?
    • •Assess liver and kidney function
    • Assess stress
    • Any PVD?
    • Any history or suspect of pheocromocytoma?
  387. 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
  388. What should you watch in pt's w/ antihypertensives?
    •Watch K+
  389. What can you drink with antihypertensives?
    Can take some meds with OJ unless contraindicated
  390. 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!
  391. 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
  392. WHat S/S do you need to check for with antihypertensives?
    • •Watch for syncope
    • Swelling in the feet, ankles, eyes
    • Assess CP and palpitations
  393. What lifestyle changes should pt's on antihypertensives do?
    • Loose weight,
    • avoid stress,
    • exersize safely
    • Watch sodium intake
  394. What can hypokalemia cause?
    •Leg cramps?
  395. What must pt's on antihypertensives be wary of?
    the OTC’s•
  396. What should pt's on antihypertensives do?
    • Change positions slowly
    • Stay hydrated
    • Oral formulas with meals to decrease GI upset
  397. What should pt's on antihypertensives avoid
    smoking or ETOH
  398. What is Hemaetopoesis?
    the process of blood cell formation (RBC's/WBC's & Plateltets)
  399. What is iron used for?
    tissue respiration
  400. What is Iron?
    a O2 carrier in Hgb & myoglobin
  401. What is Iron used in?
    many enzyme reations in the body
  402. Where is iron stored
    • liver,
    • spleen
    • bone marrow
  403. What does Iron deficiency cause?
  404. Who requires the most iron?
  405. What is iron found in?
    found in meat certain veggies grains
  406. How is iron metabolized?
    must be converted by gastric juices before they can be absorbed
  407. What foods help w/ absorption of iron?
    • OJ,
    • veal
    • fish
  408. What foods may impair absorption of iron?
    • eggs,
    • corn
    • beans
    • cereal
  409. 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
  410. What is most common in OD death in pedi?

    • iron toxicity
    • enteric coated & resemble candy
  411. 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
  412. At what is iron serum concertration are pt's at serious risk of toxicity?
    300 >ug/dl
  413. What should be done to the stomach for iron OD?
    • stomach should be emptied via ipecac syrup or lavage
    • whole gut lavage
  414. What does severe toxicity cause?
    What should be done?

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

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

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

    usually stops after 2 days

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

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

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

    it is thick
  444. what is needed on hand for iron dextran IV
    emer equip
  445. what should pt's taking b12 eath
    • diet high in b12
    • fish oysters egg yolk
    • organ meet
    • dairy
    • clams

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Pharm IV
2012-04-20 20:47:49

Heart Failure
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