NR 293 Exam 3 Study Guide

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NR 293 Exam 3 Study Guide

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 Slow progression of left ventricular hypertrophy after MI (cardio protective)  Renal protective effects in patients with diabetes  Captopril and lisinopril can be used if a patient has liver dysfunction, unlike other ACE inhibitors that are pro-drugs  *Pro-drugs are inactive in their administered form and must be metabolized in the liver to an active form so as to be effective

o Adverse Effects: hyperkalemia & dry, nonproductive cough

o Serious drug interaction: NSAIDs

 Angiotensin II receptor blocker “sartan” losartan (Dovan)

o Mechanism of Action:

 Allow angiotensin I to be converted to angiotensin II, but block the receptors that receive angiotensin II  Block vasoconstriction and release of aldosterone  Well tolerated, do not cause a dry cough

 Indications: first-line treatment for heart failure & HTN

o Adverse Effects: URI, headache

 May cause occasional dizziness, inability to sleep, diarrhea

 Calcium channel blockers: Amlodipine “dipine” verapamil (calan), diltiazem (cardizem)

o Mechanism of Action: cause smooth muscle relaxation by blocking the binding

of calcium to its receptors, preventing muscle contraction

o Adverse effect: constipation

 High-fiber diet with plenty of fluids will help prevent constipation

o Indications: hypertension

 Angina- ch. 23

 Ischemia:

o Ischemic heart disease: Poor blood supply to the heart

muscle (Atherosclerosis, Coronary artery disease)

o Myocardial infarction (MI): Necrosis, or death, of cardiac

tissue, disabling or fatal  Therapeutic Objectives

• Minimize the frequency of attacks and decrease the

duration and intensity of anginal pain

• Improve the patient’s functional capacity

o Prevent or delay the worst possible outcome: MI

 Cardiac glycosides: Digoxin

o Therapeutic level: between 0.5-2ng/mL 2 / 3

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• Digoxin doses are held and the prescriber notified if the apical pulse is 60

beats/minute

• Negative chronotropic effect decreases HR
• Digoxin immune Fab (Digifab) is the antidote for a severe digoxin overdose

 Required use of digitab when potassium level is above 5 mEq/L, severe sinus bradycardia that does not respond to cardiac pacing, or an overdose of more than 10 mg of digoxin.

• Avoid bran muffins when taking digoxin
• Hypokalemia increases the chance of digitalis toxicity

 Class III drugs: Amiodarone (ch. 25)

o Mechanism of action: prolonging action potential duration

o Indications: ventricular dysrhythmias

o Contraindication: hypersensitivity and bradycardia or AV block

Adverse effects: FDA black box warning: pulmonary toxicity, hepatotoxicity arrhythmia worsening-sinus bradycardia, constipation, QT prolongation, hypotension, blue-gray coloring of the skin on the face, arms, and neck

 Unclassified antidysrhythmics: Adenosine (Ch. 25)

 Slows conduction through the AV node  Used to convert paroxysmal supraventricular tachycardia to sinus rhythm  Very short half-life (less than 10 seconds)  Flush with 20cc of normal saline  Only administered as fast IV push  May cause asystole for a few seconds  Adverse Effects  ALL antidysrhythmics can cause dysrhythmias! Hypersensitivity reactions, nausea, vomiting, diarrhea, dizziness, blurred vision, headache  Assessment  Obtain a thorough drug and medical history  Baseline BP, P, I&O, and cardiac rhythm  Measure serum potassium levels before initiating therapy  Conditions that may be contraindications for use of specific drugs  Potential drug interactions  During therapy,  Monitor cardiac rhythm, heart rate, BP, general well-being, skin color, temperature, heart and lung sounds  Assess plasma drug levels as indicated  Monitor for toxic effects

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