Term
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Definition
| major cause of atherosclerosis |
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Term
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Definition
most cause of MI, CVA, and PVD
Low HDL and high LDL are risks for atherosclerosis and CAD |
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Term
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Definition
| Diet, exercise and other lifestyle changes attempted first |
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Term
| What are some other lifestyle changes that should be made in order to help decrease hyperlipidemia? |
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Definition
Decrease alcohol intake
Decrease lean food
Quit smoking |
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Term
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Definition
Actions:
Binds with bile acids in intestine to decrease cholesterol (CHOL)
Uses:
Antilipemic
Treats pruritus due to biliary stasis
Treats diarrhea caused by excess bile acids
Side effects:
Constipation
Decreases absorption of fat soluble vitamins and many other oral meds
Example:
Questran (cholestyramine) – should be given 1 hour and 4 hours after meds, to prevent from binding with other meds, don’t mix with carbonated beverages.
This drug is not hepatotoxic. |
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Term
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Definition
a water-soluble B3 vitamin
High doses decreases CHOL |
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Term
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Definition
Facial flushing
Itching
Hypotension
Hepatotoxic
It is believed that facial flushing and itching is the effect of the release of niacin. |
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Term
| Which antilipemic agents would cause hepatotoxicity? |
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Definition
| Niacin, statins, fibric acids |
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Term
| HMA-CoA Reductase Inhibitors (statins) |
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Definition
| Most potent antilipemic agents available |
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Term
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Definition
Zocor (simvastatin)
Lipitor (atorvastatin) |
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Term
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Definition
Myopathy (rhabdomyolosis) – breakdown of muscles, cause renal failure, pt complains of muscle ache, muscle soreness, and muscle weakness
Which chol meds will cause rhabdomyolosis? Statins, fibric acids
Hepatotoxicity
Best time to take this is at bedtime. Cholesterol is mostly produced by the liver at night.
Grapefruit juice increases the level of cholesterol increasing side effects |
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Term
| Which chol meds will cause rhabdomyolosis? |
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Definition
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Term
| Myopathy (rhabdomyolosis) |
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Definition
| breakdown of muscles, cause renal failure, pt complains of muscle ache, muscle soreness, and muscle weakness |
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Term
| HMA-CoA Reductase Inhibitors (statins) |
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Definition
Best time to take this is at bedtime. Cholesterol is mostly produced by the liver at night.
Grapefruit juice increases the level of cholesterol increasing side effects |
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Term
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Definition
| Most effective agents in lowering triglycerides |
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Term
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Definition
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Term
| Fibric Acids Side effects: |
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Definition
Myopathy (rhabdomyolosis)
Hepatotoxicity |
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Term
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Definition
Fish oils
Can be combined with statins
Does not cause myopathy (rhabdomyolosis) |
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Term
Miscellaneous Antilipemic
Zetia (ezetimibe) |
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Definition
Blocks absorption of chol by intestine
Can be used along with statins
Cal elevate liver enzymes when used with statins
Vytorin is a combination of Zocar and Zetia, monitor liver function tests, |
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Term
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Definition
| Condition characterized by increase in systolic B/P, diastolic or both |
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Term
| Goals in treating hypertension in patient with co-existent diseases: |
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Definition
Renal disease and DM
Maintain B/P less than 130/80
CHF
Maintain B/P 120/80 |
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Term
| Patient teaching for Hypertension |
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Definition
Take meds as prescribed (even when B/P normal)
Don’t take extra doses or skip doses
Some antihypertensive agents can cause impotence
If one antihypertensive is not effective, then other antihypertensive agents can be added (step
approach)
Encourage monitoring B/P at home, check it at different time of the day
Some antihypertensive meds cause drowsiness for first few weeks
Elderly people are more susceptible to orthostatic hypotension |
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Term
| Beta Adrenergic Blocking Agents |
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Definition
Blocks cardiac response to sns stimulation
Decrease heart rate
Decrease B/P
Decrease force of myocardial ctx |
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Term
| Beta Adrenergic Blocking Agents Examples |
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Definition
Tenormin (atenolol)
Lopressor (metoprolol)
Inderal (propranolol |
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Term
| Beta Adrenergic Blocking Agents note |
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Definition
| Monitor blood pressure and pulse, because this drug could potentially decrease it. |
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Term
| Ace Inhibitors (angiotensin converting enzyme inhibitors) |
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Definition
Action:
Prevents the conversion of angiotensin I to angiotensin 2
Decrease b/p
Decreases secretion of aldosterone.
Decrease sodium and water retention |
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Term
| Ace Inhibitors (angiotensin converting enzyme inhibitors) Examples: |
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Definition
Vasotec (enalapril)
Zestril (lisinopril) |
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Term
| Ace Inhibitors (angiotensin converting enzyme inhibitors) note |
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Definition
B/P should be assessed before ACE inhibitors
Monitor potassium, aldosterone causes the potassium to elevate.
Salt substitute be avoided because they substitute it with potassium. |
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Term
| Angiotensin II receptor Antagonists (ARBs) |
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Definition
Action:
Decreases effects of angiotensin ii by preventing angiotensin ii from binding to receptor sites
Decrease B/P
Decrease Na+ retention |
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Term
| Angiotensin II receptor Antagonists (ARBs)Examples: |
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Definition
Cozaar (losartan)
Atatcand (candesartan)
Avapro (irbesartan) |
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Term
| Aldosterone Receptor Antagonist |
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Definition
Action:
Prevents Na+ and H2O retention by blocking receptor stimulation by aldosterone
Example:
Inspra (eplerenone) |
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Term
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Definition
Action:
Blocks renin
Prevents angiotensin ii from activating its receptors which decreases catecholamine release
Decreases aldosterone secretion
Decreases Na+ reabsorption
Example:
Tekturna (aliskiren) |
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Term
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Definition
Action:
Inhibits the movement of Ca++ across cell membrane
Causes vasodilation
Decreases B/P
Some decrease heart rate and weaken force of myocardial contraction
Example:
Procadia (nifedipine)
Norvasc (amlopidine)
Calan (verapamil)
Cardizem (diltiazem)
Cardizem XL
Check B/P before administering B/P meds. |
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Term
| Alpha 1 Adrenergic Blocking Agents |
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Definition
Actions:
Blocks alpha 1 adrenergic receptor site
Vasodilation of arterioles
Decrease B/P
Example:
Cardura (doxazosin)
Give this at bedtime to decrease chances of orthostatic hypotension.
This helps with BPH. |
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Term
| Centrally acting alpha 2 agonist |
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Definition
Action:
Stimulates alpha 2 receptors
Prevents the release of norepinephrine and that lower B/P
Decreases effects of SNS
Decreases B/P
Decreases heart rate
Example:
Catapres, Catapres TTS (clonidine), TTS is a patch, patch can be worn for 7 days, it comes with overlay to prevent it from coming off. Check the pulse when giving clonidine. Pt complains that this causes sedation. |
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Term
| Peripherally acting antiadrenergic |
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Definition
Action:
Uses up stores of norepinephrine and prevents its release
Example:
Reserpine |
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Term
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Definition
Action:
Acts directly on smooth muscles of blood vessels
Causes vasodilation
Examples:
Apresoline (hydralazine)
Loniten (minoxidel) – used for baldness
Nipride (nitroprusside sodium) – emergency drug when B/P is dangerously low, given in continuous drip, then you titrate according to the pt’s condition. Very sensitive to light. Monitor B/P very frequently and very closely. |
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Term
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Definition
| when the heart is unable to meet the demand of the body. Decreased cardiac output. |
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Term
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Definition
| a cluster of S/S that arise when the ventricles (left, right, or both) lose the ability to pump enough blood to meet the body’s circulatory needs. |
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Term
| The body compensates for inadequate output by: |
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Definition
SNS releasing epinephrine and norepinephrine
Increases the heart rate, causes tachycardia, therefore increasing cardiac output
Causes tachycardia
Increased contractility
Peripheral vasoconstriction – makes the heart work harder
Increased afterload forces a further decrease in CO
Afterload is the amount of blood that the ventricles are pumping out
Decreased renal perfusion
Renin-angiotensin-aldosterone system
Stimulates renal distal tubules to retain sodium and water retention
Increases workload on heart
Increased production of vasopressin
Kidneys increases sodium reabsorption to expand circulating blood volume
Increased pressure within capillaries
Results in edema |
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Term
| Three therapies used for treatment of heart failure |
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Definition
Vasodilator
Inotropic
Diuretic |
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Term
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Definition
| – decrease the strain on left ventricle by reducing SVR systemic vascular resistance (afterload) |
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Term
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Definition
| – increase the force of myocardial contraction, boosts cardiac output by stimulating the heart to increase force of contractions |
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Term
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Definition
| helps in decreasing of sodium and water, enhances sodium and water excretion which decreases of workload of heart |
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Term
Digitalis Glycosides
Lanoxin (digoxin) |
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Definition
Treats systolic failure not responding to diuretics and ACE inhibitors
Two primary actions on the heart:
Positive inotropic action – increases the force of contraction
Negative chronotropic action – slows the heart rate
Typical dose:
0.125-0.25 mg/day |
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Term
| Digitalization (loading doses) |
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Definition
Larger dose for an initial period of 24 hours
Reaches therapeutic dose faster
Older adults frequently experience digoxin toxicity
Monitored closely for digoxin toxicity
Nausea and vomiting, bradycardia, cardiac arrhythmia, visual disturbances.
Low potassium levels will increase chances of digoxin toxicity |
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Term
| Nursing implications for digitalis glycosides |
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Definition
Check apical pulse for one minute, hold it if its lower than 60.
Monitor potassium levels
Monitor digoxin levels |
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Term
| Phosphodiesterase Inhibitors |
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Definition
Inotropic agent increases force of myocardial contractions
Short-term management of heart failure in patients responsive to digoxin, diuretics, or vasodilator therapy
Example:
Inorcor (inamrinone) |
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Term
| Angiotensin-Converting Enzymes Inhibitors (ACE inhibitors) |
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Definition
Inhibits the enzyme that converts angiotensin I to angiotensin ii
Decreases B/P
Decreases secretion of aldosterone
Decreases Na+ and H2O retention
Examples:
Vasotec (enalapril)
Zestril (lisinopril) |
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Term
| Beta adrenergic blocking agents |
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Definition
Given with other drugs such as ACE inhibitors to decrease HF symptoms
Examples:
Coreg (carvedilol)
Toprol XL, Lopressor (metoprolol) |
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Term
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Definition
Relaxes blood vessels and lowers B/P
Examples:
Apresoline (hydralazine)
Isordil (isosorbide dinitrate)
Bidil (hydralazine and isosorbide dinitrate) |
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Term
Natriuretic Peptides (only given IV)
Human B type natriuretic peptide |
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Definition
Hormone secreted by ventricles in response to fluid and pressure overload
Reduces preload and afterload
Preload is the amount of venous blood that is returning to the heart
Increases diuresis and sodium excretion
Suppresses renin-angiotensin-aldosterone system
Decreases secretion of norepinephrine
BNP lab, if its greater than 100, then its heart failure
Example:
Natrecor (nesiritide)
Used in patients with severe heart failure who have dyspnea at rest or with minimal activity. |
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Term
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Definition
| caused by firing of abnormal pacemaker cells, and /or the blockage of normal electrical pathways. |
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Term
Drugs used to treat dysrhythmias
Goal of treatment: |
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Definition
Restore normal sinus rhythm (NSR)
Restore normal cardiac function
Prevent recurrence of life-threatening dysrhythmias |
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Term
| Antidysrhythmic agents classified according to effects on electrical conduction system |
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Definition
Monitor heart rate, rhythm, and B/P
All have the potential to decrease heart rate and B/P
Cardiac monitor if given IV |
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Term
| Beta Adrenergic Blocking Agents |
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Definition
Used to treat certain types of tachycardia
Some suppress irritable ventricles
Example:
Inderal (propranolol)
Lopressor (metoprolol) |
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Term
|
Definition
Treats atrial and ventricular arrhythmias
Side effects:
Hypotension
Lupus-like syndrome |
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Term
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Definition
Treat ventricular arrhythmias
Side effects:
Hypotension
Seizures |
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Term
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Definition
Used in management of life threatening arrhythmias
Side effects:
Adverse reaction very common
Can cause other arrhythmias |
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Term
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Definition
Used to convert PSVT (paroxysmal supraventricular tachycardia) to normal sinus rhythm (NSR)
Side effects:
Causes a few seconds of asystole |
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Term
|
Definition
Used to decrease heart rate in certain types of arrhythmias. Monitor heart rate and B/P.
Calan (verapamil)
Cardizem (diltiazem) |
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Term
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Definition
Increases myocardial oxygen supply
Coronary vasodilator
Decrease oxygen demands on heart
Causes peripheral vascular smooth muscle relaxation
Reduces venous blood return to the heart
Administration forms:
Sublingual tablets
Can be given in anticipation of angina
Treat acute angina attacks
Sustained-release capsules, tablets, ointment, transmucosal tablets, and transdermal patches
Used to prevent angina attacks
Translingual spray
Intravenous |
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Term
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Definition
Usual dose: 0.4 mg (gr 1/150)
Have pt sit or lie down – prevents orthostatic hypotension
3 NTG can be given 5 minutes at a time
Only good for 6 months
Take out the cotton upon initial opening of the bottle, cotton might absorb NTG
Cant be kept in any luggage compartment |
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Term
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Definition
Prevents angina attacks
Decrease peripheral resistance in CHF
Dose prescribed in inches using special paper
Application:
Do not apply on hairy areas (clip hair if necessary)
Avoid contact with nurses’ skin
Rotate sites |
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Term
|
Definition
Prevents angina attacks
Releases NTG for up to 24 hours
Patch is usually worn for 12-14 hours and removed for 10-12 hours at night to prevent
a tolerance to NTG.
Refer to text for application technique |
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Term
|
Definition
Used in ER and critical care areas
Used to treat angina pain, CHF
Must use special IV tubing
Always administer using volumetric pump
Closely monitor B/P |
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Term
|
Definition
Nitrostat, Nitrobid (nitroglycerine)
Isordil (isosorbide dinitrate)
Imdur (isosorbide mononitrate) |
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Term
|
Definition
Hypotension
Prolonged headache
Tolerance with prolonged use |
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Term
|
Definition
ETOH
Calcium ion antagonists, beta-adrenergic blocking-agents (lower blood pressure)
Viagra (sildenafil): CONTRAINDICATED!
Fatal drop in blood pressure possible
Monitor:
B/P and pulse, decreases B/P but increases pulse. We worry really about the B/P. |
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Term
| Beta-Adrenergic Blocking Agents |
|
Definition
Action:
Blocks SNS (beta adrenergic receptors in the heart)
Reduces myocardial oxygen demand
Uses:
Prevents frequency and severity of angina attacks
Tx hypertension
Antirhythmics because it decrease heart rate
Decreases the mortality rate with MI and prevent MI reoccurrence
Antirrhythmics decreases heart rate
Side effects:
Decreased B/P
Bradycardia
CHF
Drowsiness
Masks s/s of hypoglycemia in diabetic receiving antidiabetic meds
Monitor:
Heart rate
B/P |
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Term
|
Definition
Action:
Inhibits flow of calcium ion cross cell membrane
Dilates peripheral vessels
Improves coronary blood flow
Reduces myocardial oxygen demand
Uses:
Prevents angina attacks
Tx hypertension
Antiarrhythmic (decreases HR especially with atrial fibrillation)
Side effects:
Decrease B/P
Bradycardia
CHF
Peripheral edema
Monitor:
B/P and pulse |
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Term
|
Definition
Action:
Inhibits the conversion of angiotensin I to angiotensin II
Decreases aldosterone
Uses:
Hypertension
CHF
Secondary prevention of MI
Side effects:
Lowers B/P
Hypotension
Chronic cough
Monitor:
B/P
Example:
Altace (ramipril) |
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