Pharmacology Cardiac Drugs

What is Atherosclerosis?
It a disease characterized by deposits if fatty plaques on the inner was of arties.

What does the fatty plaques on the inner was do?
The deposits result in a narrowing of the lumen (inner diameter) of the artery and a decrease in blood supply to the area served by the artery.

What does vasodilating drugs do?
Vasodilating drugs relax the smooth muscle layer of the arterial blood vessels which result in vasodiltion.

What is Vasodilation?
Vasodilation is an increase in the size of blood vessels, primarily small arteries and arterioles.

What is Angina?
Angina is a disorder characterized by Atherosclerotic plaque formation in the coronary arteries, which causes decreased oxygen supply to the heart muscle and results in chest pain or pressure.

What does Antianginal drugs do?
Antianginal drugs relieve chest pain or pressure by dilating coronary arteries, increasing the blood supply to the myocardial.

What are Antianginal drugs include?
Nitrates and the calcium channel blockers

What do nitrates do?
Nitrates act by relaxing the smooth muscles layer of the blood vessel, increasing the lumen of the artery to arteriole and increasing the amount of blood flowing through the vessels.

What effects does calcium blocker have?
• Slowing the conduction velocity of the cardiac impulse
• Depressing myocardial contractility
• Dilating coronary arteries and arterioles which in turn deliver more oxygen to cardiac muscles

Antianginal drugs are used in the treatment of cardiac disease to?
• Relieve pain of acute angina attacks
• Prevent angina attacks (prophylaxis)
Treat chronic stable angina pectoris

Adverse Reaction to the calcium channel clocking drugs are?
• Central nervous system (CNS) reactions, such as headaches (may be persistent), dizziness, weakness, and restlessness
• Other body system reactions, such as hypotension, flushing (caused by dilation of small capillaries near the surface of the skin) and rash

Nitrates are available in various form what are they?
• Sublingual
• Translingual spray
• Transdermal
• Parenteral

Nitrates Contradictions in patients are?
• Severe anemia
• Closed angle-glaucoma
• Postural hypertension
• Early myocardial infarction (sublingual form)
• Head trauma
• Cerebral hemorrhage (may cause intracranial hemorrhage)
• Allergy to adhesive (Transdermal system)
• Constrictive pericaditis
• Patients taking Phosphodiesterase inhibitors (for erectile dysfunction) should not use nitrates

Nitrates are cautiously used in patients with?
• Severe hepatic or renal disease
• Severe head trauma
• Hypothyroidism

Nitrates interactions are?
• Aspirin
• Calcium channel blockers
• Dihyroergotamine
• Heparin
• Phosphodiesterase inhibitors

What pre administration information is obtained for patients receiving Antianginal drugs?
• Assess the physical appearance of the patient (skin color, lesions)
• Auscultates the lungs for adventitious sounds
• Obtain a baseline electrocardiogram
• Vital signs

What do you do for your on going assessment of Antianginal drugs?
• Monitor patient for frequency and severity of any episodes of angina pain
• Report chest pain that does not respond to three doses of nitroglycerin given every 5 minutes for 15 minutes
• If patients heart rate falls below 50 beats beat per minutes or systolic blood pressure drops below 90 mm Hg, the drug is withheld
• Nurse should assess patient receiving the calcium channel blockers for signs of heart failure: dyspnea, weight gain, peripheral edema abnormal lung sounds (crackles/rales) and jugular vein distention

Nursing Diagnoses Antianginal drugs
• Risk for injury – related to hypotension, dizziness, lightheadedness
• Pain related to narrowing of peripheral arteries decreased blood supply the extremities

How can Nitrates be taken
sub-lingual under the tongue or Buccal (between the cheek and gum) oral, IV, or Trans-dermal route. Buccal tablet between cheek and gum or between upper lip and gum to allow to dissolve. Dry mouth decreases absorption.

Nitro can be administered by a metered spray canister that is used to abort an acute angina attack. Spray directly on the tongue

Giving Nitrates orally
on empty stomach, do not crush or chew

Giving Nitrate ointment
topical (ointment) id measured in inches or millimeters; 1 inch equals 15mm of nitro
• obtain patients blood pressure, pulse rate, compare with baseline and previous vital signs
• remove old application, wearing gloves to prevent contact with medication,
• Nurse uses applicator or dose measure paper to gently spread a thin unform layer over at least a 2 ¼ by 3 ½ inch area. The ointment is usually applied to the chest or back. Abdomen and upper arm and legs.

Why shouldn’t the nurse rub the nitroglycerin ointment into the patient’s skin?
Nitro will deliver a larger amount of the drug through the skin immediately.

How are nitro Trans-dermal systems administered?
A Trans-dermal system has the drug impregnated in a pad. It’s applied to the skin for up to 12 hours once a day

How is nitro IV is administered?
Nitro IV is diluted in normal saline or 5% dextrose in water (D5W) by continuous infusion using an infusion pump to ensure accurate rate.

How are calcium channel blockers taken?
Calcium channel blocker can be taken with or with out food

Verapmil adverse reaction
frequently cause gastric upset and the nurse should routinely give tablets with meals.

When administering the nitrates for angina pectoris, the nurse monitors the patients for which common adverse reaction?

When teaching a patient a patient about prescribe sublingual nitroglycerin, the nurse informs the patient that if pain is not relieved, the dose can be repeated in ___ minutes.
5 minutes

When administering nitroglycerin ointment, the nurse ______.
Applies the ointment to a clean dry area

A patient is taking a calcium blocker experience orthostatic hypotension. The nurse instructs the patient with orthostatic hypotension to _____.
Make position changes slowly to minimize hypotensive effects

Mr. Philips has seen his primary health care provider for his heart condition. The doctor has you call a prescription for sublingual nitrate. Mr. Phillips hands you other prescriptions. Which one should you review with the primary health care provider first?

What is the process of homeostasis?
When a blood vessel is injured, a series of event occurred to form a clot and stop the bleeding

How did the blood clotting or coagulation cascade get its name?
Because as each factor is activated, it acts as a catalyst that enhances the next reaction with the net result being a large collection of fibrin (the clot) that forms a plug in the vessel, thus stopping the bleeding.

What does a Thrombosis do?
It’s the formation of a blood clot or thrombus

How can Arterial thrombosis occur?
Arterial thrombosis can occur because of atherosclerosis or arrhythmia’s, such as a trial fibrillation.

When a thrombus detaches itself from the wall of the vessel and is carried along through the bloodstream is called?

Embolus goes to the lung and obstructs a pulmonary vessel it is called?
Pulmonary Embolism (PE)

Drugs that prevent the formation of clots are called?

Drugs that suppress platelet aggregation?

Drugs that help to eliminate the clot are called?

________ has no direct effect on an existing thrombus and do not reserve any damage from the thrombus

Once the presence of a thrombus as been established, __________ can prevent additional clots from forming.
Anticoagulant Therapy

_________ is the oral anticoagulant most commonly prescribed.
Warfarin (Coumadin)

Peak activity for warfarin is reach at?
1.5 to 3 days after therapy is initiated

Heparin is used for?
Thrombosis/embolism diagnosis and treatment of disseminated intravascular coagulation prophylaxis of DVT, clotting preventing

Parental Anticoagulat

Oral Anticoagulants
warfarin -Coumadin

Parenteral Anticoagulants: Low-Molecular-Weight Heparins
Enoxaparin – Lovenox

Antiplatelet Agents
Clopidogrel – Plavix

What does Anticoagulants interfere with?
Clotting Mechanism

The LMWHs act to inhibit clotting reactions by binding to _________, which inhibits the synthesis of factor X and the formation of thrombin.
antithrombin III

the nurse instructs the patient using the transdermal system Catapres TTS to________.
place the patch on the upper arm or torso and keep it in place for 7 days

To avoid symptoms associated with orthostatic hypotension, the nurse advise the patient_______.
change position slowly

After the first dose of an ACEI , the nurse monitors_____
the blood pressure every 15 to 30 minutes for at least 2 hours

During the preadministration assessment of a patient prescribe an antihypertensive drug, the nurse
places the patient in a supine position

when administrating the nitrates for angina pectoris, the nurse monitors the patient for which common adverse reaction?

When teaching a patient about prescribed sublingual nitroglycerin, the nurse informs and patient that if pain is not relieved the dose can be repeated in______
5 minutes

When administering nitroglycerin ointment, the nurse _______.
applies the ointment to a clean dry area

a patient is taking a calcium channel blacker experiences orthostatic hypotension. The nurse instructs the patient with orthostatic hypotension to______.
make position changes slowly to minimize hypotensive effects

The patient is receiving oral anticoagulant drug therapy. before administering the drug, the nurse__.
see that blood has been drawn for a baseline PT evaluation

Optimal INR during therapy is____.
between 2 and 3

There is an increase risk for bleeding when the patient receiving heparin is also taking____.

In which of the following situations would the nurse expect an dalteparin to be prescribed?
to prevent a DVT

If bleeding is noted while a patient is receiving a thrombolytic drug, the patient may receive
whole blood or fresh plasma

Which of the following is commonly associated with left venticular systolic dysfunction?
ejection fraction below 40%

Which of the following serum digoxin levels in an adult would be most indicative that the patient may experiencing digoxin?
0.5 nanograms/dL

In which of the following situations would the nurse with hold a dose of digoxin and notify the physician
pulse rate of 50 bpm

During rapid digitalization, the nurse expects the first dose to be______.
approximately half of the total digitalization dose

Which of the following adverse reactions of lidocaine (xylocaine) should be reported immediatley to the primary health care provider
sudden change in mental status

Which of the following drugs, when given with dispyradisopyramide (Norpace) would possibly increase the serum disopyramide levels?

Common adverse reactions of the antiarrhythmic drugs include_____.
lightheadness, hypotension, and weakness

Which of the following statements would the nurse include in a teaching plan fir the patient taking antiarrhythmic drug on an outpatient basis?
avoid drinking alcohol beverages unless their consumption has been approved by the primary health care provider

When administering quindine (Quinidex) the nurse reports a blood level greater than___.

Cinchonism is____?
a term use to describe quinidine toxicity. Cinchinism occurs with high blood levels of quinidine (greater than 6mcg/dL)

Dryness of the mouth and throat are caused by______.
the cholinergic blocking action of disopyramide, the nurse instructs patient to suck on hard candy

if procainamide is given IV the nurse maintains continuous and clase cardiac monitoring. Hypotension may occur with IV administration; therefore blood pressure must be monitored every ______while the drug is being infused.
15 minutes

Antiarrhythmic Drugs nursing diagnoses
nausea related to antiarrhythmic drugs
urinary retention related to cholinergic blocking effects of drugs
impaired oral mucous membranes related to dry mouth
risk for injury related to dizzness, light-headedness
risk for infection related to agranulocytosis

A transient increase in arrhythmias and hypertension may occur within ______after initial therapy with bretylium is begun.
1 hour

The patient is usually placed on a_______ before antiarrhythmic drug therapy is initiated. In addition the primary health care provider may order an____to provide baseline data for comparison during therapy
cardiac monitor, ECG

classIV channel blocker

class III class blockers

class II b-adrenergic blockers

class i sodium channel blocker

antiarrhythmic drugs are used to treat:
ventricular tachycardia
premature atrial contractions
paroxymal atrial tachycardia
other atrial arrhythmias, such as atrial fibrillation or flutter
tachycardia when rapid but short term control of ventricular rate is described

calcium channel blockers
inhibit the movement of calcium through channels across the myocardial cell membranes and vascular smooth muscle. Cardiac and smooth muscle depends on the movement of calcium ions into the muscle cells through specific ion channels

class IC drugs action
slight effect on repolarization
profound slowing of conduction

class IB drugs
shorten the action potential duration
selectively depress cardiac conduction

class IA drug
prolong the action potential
produce moderate slowing of cardiac conduction

Disopyramide decreases _________ of myocardial fibers during the diastolic phase of the cardiac cycle, prolongs the refractory period and increases the action potential duration of normal cardiac cells.

when nerve cell is polarized positive ions (+) are on the outside of the cell membrane and the negative ions (-) are on the inside of the cell membrane

in response to a stimulus, the positive ions move from the outside to the inside of the cell membrane while the negative ions move to the outside

after the stimulus has passed along the nerve fiber, the ions move back to their original place until another stimulus occurs

left ventricular dysfunction
leads to pulmonary symptoms such as dyspnea and moist cough with the production of frothy pink sputum

right ventricular dysfunction
leads to neck vein distention, perpheral edema weight gain and hepatic engorgement

HF, atrial fibrillation

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