nurse test (2nd page)

causes of heart failure

CAD
mitral valve stenosis

MI/heart attack

chronic uncontrolled hypertension

diabetes

dyslipidemia

thyroid disorders

treatment of heart failure

stage A-D

stage A

increased risk of heart failure without structural heart disease

stage B

pre-heart failure:structural evidence heart disease with our without symptoms of failure

stage C

symptomatic heart failure: structural evidence of heart disease with current or previous symptoms of congenital heart failure

stage D

advanced heart failure: symptoms at rest

medications specific to heart failure

cardiac glycosides

phosphodiesertase IV inhibitors

entresto

phosphodiesterase inhbititors

beta adrenergic agonist

medications in the cardiac glycosides class

digitalis/digoxin

digoxin function

works by increasing the strength of myocardial contraction which increases cardiac output. Can also suppress the electrical conductivity of the heart

common side effects of cardiac glycosides

dysrhythmia or bradyarrhytmia, GI upset, fatigue, visual disturbances

serious adverse events of cardiac glycosides

profound arrhythmia, AV block, CNS effects, intestinal ischemia: high risk of toxicity, overdose can be fatal

drugs in the phosphodiesterase IV inhibitor class

sildenafil, varendafil, tadalafil - the “FILS”

common side effects of phosphodiesterase IV inhibitor

headache, flushing, GI upset, visual disturbances

serious adverse events of phosphodiesterase IV inhibitor

severe hypotension, anaphylaxis

Sacubitril

Neprilysin Inhibitor; vasodilatory.

Dapagliflozin

(Farxiga); inhibits sodium-glucose cotransporter 2 (SGLT2)-FDA indicated for heart failure
associated risk reduction; CKD risk reduction

Causes of Dysrhythmia

1.Hypertension
2. Cardiac valve disease
3. CAD
4. Medications (digoxin)
5. Hypokalemia/hypomagnesemia
6. MI
7. CVA
8. DM
9. Heart Failure

pharmacologic treatments for dysrhythmia

sodium channel blockers

beta-adrenergic blockers

potassium channel blockers

calcium channel blockers

sodium channel blocker drugs

procainamide, lidocaine, flecainide

beta-adrenergic blocker drugs

propranolol

potassium channel blocker drugs

amiodarone

calcium channel blocker drugs

verapamil, diltiazem

Amiodarone

has Black Box Warnings for appropriate use, pulmonary toxicity, hepatotoxicity, and
proarrhythmic effects.

Flecainide

has Black Box Warnings for proarrhythmic effects and increased mortality

Propafenone

has Black Box Warnings for increased mortality

Beta Adrenergic Antagonists, sotalol

has Black Box Warnings for appropriate use, life-threatening
proarrhythmic effects, and non-interchangeable forms

Calcium Channel Blockers, diltiazem

A fib/flutter; verapamil-PSVT conversion/prevention. No Black Box
Warning for either drug

Atropine

bradycardia (antagonizes acetylcholine receptors)

lidocaine

ventricular arrhythmia (inhibits sodium ion channels)

procainamide

ventricular/supraventricular arrythmia-Black Box Warning (proarrhythmic effects, +ANA
titers, blood dyscrasias (stabilizes membranes

Anaphylactic

severe allergic reaction (usual allergens include PCN, nuts, shellfish).

cardiogenic shock

failure of the heart to pump blood to vital organs. Usually caused by left heart failure, MI, PE, dysrhythmia, myocardial infection

hypovolemic shock

severe loss of blood volume. Usually due to massive hemorrhage, burns, severe dehydration (excessive diuresis, N&V, diarrhea)

neurogenic shock

vasodilation due to overstimulation of the parasympathetic nervous system or under stimulation of the sympathetic nervous system. This occurs with trauma to the spinal cord/brain stem, severe emotional distress/pain, CNS depressants

septic shock

multiorgan dysfunction due to infection (within the bloodstream). Leads to ARDS/DIC. Caused by an “inflammatory storm” response to infection

Symptoms of shock include

CNS

cardiovascular

skin

respiratory

metabolic

CNS shock symptoms

restlessness, anxiety, confusion (early) followed by lethargy and LOC (late

cardiovascular shock symptoms

low BP and cardiac output, increased HR, thready pulse

skin shock symptoms

pale, clammy, cool

respiratory shock symptoms

rapid breathing followed by shallow breathing

metabolic shock symptoms

decreased body temperature, thirst, low urine output-acidosis

treatments for shock

fluid replacement

treating hyportension

anaphylaxis

fluid replacement treatment for shock

blood products, colloids (albumin-plasma expanders), and crystalloids (IVF)

treating hypotension regarding shock

vasoconstrictors (vasopressors) and adrenergic agonists/inotropic

vasoconstrictors

these drugs activate the sympathetic nervous system (dopamine, epinephrine, norepinephrine, digoxin, dobutamine)

anyphylactic treatment of shock

in addition to the above, antihistamines, albuterol, and systemic corticosteroids may also be used.

Macrocytic-normochromic size of RBCs

larger than normal

Microcytic-hypochromic. Size of RBCs

smaller than normal

normocytic-normochromic size of RBCs

normal

Macrocytic-normochromic

irregularly shaped RBCs with normal hemoglobin concentrations-pernicious anemia (B12), folic acid (folate) deficiency anemias

Microcytic-hypochromic

rregularly shaped RBCs with decreased
hemoglobin concentrations-iron deficiency anemia, thalassemia

Normocytic-normochromic

are destroyed/depleted-aplastic anemia, hemorrhagic anemia, hemolytic anemia, sickle-cell anemia (anemia of chronic disease)

Symptoms of anemia

pallor, fatigue, SOB, increased HR

treatment for anemia

vitamin B12

folic acid

iron

vitamin B12 treatment for anemia

available for injection, in tablet form, and as a nasal spray

folic acid treatment for anemia

can be given via multiple routes, generally used in pill for

iron treatment for anemia

salts can also be given via various routes. Iron supplements exist as ferrous sulfate, ferrous gluconate, ferrous fumarate

Neurological symptoms of anemia

are associated with B12 deficiency; intrinsic factor required for absorption.

folic acid deficiencies of anemia are associated with

neural tube defects in babies

cells responsible for hematopoiesis

ed blood cells, white blood cells, platelets, and lymphocytes

coagulation disorder are also referred to as

bleeding disorders, occur due to low platelets or clotting factor deficiencies.

coagulation disorders

von Willebrands disease

hemophillia

thrombocytopenia

thrombocytopenia

a platelet count below the normal range

thromboembolic disorders

disorders in which an undesirable clot has formed. The undesirable clot is
called a thrombus. When a thrombus breaks free and travels through the blood stream, it is referred to as an embolus.

where does a thromboembolic disorder occur

veins or arteries and require prompt (if not urgent) medical attention.

Common disorders requiring anticoagulation include

atrial fibrillation (a-fib), deep vein thrombosis (DVT), and presence of a mechanical heart valve

drugs used for thromembolic disorders are

anticoagulant

anticoagulant medication

heparin

warfarin

low-molecular weight heparin

direct thrombin inhibitors

factor Xa inhibitors

warfarin (Coumadin)

vitamin K reversal

low-molecular weight heparins

enoxaparin (Lovenox)

direct thrombin inhibitors

dabigatran (Pradaxa)-idraucizumab (praxiband) for reversal

factor Xa inhibitors

apixaban, rivaroxaban (Xareto) - andexanet alpha for reversal

anti platelet drugs function

inhibit coagulation through their effect on platelets

anti platelet drugs are used to

prevent clots in arteries

who generally uses anticoagulant medication

used to treat clots in veins and as stroke prevention for patients with A-fib

common side effects of anticoagulant medication

GI upset, minor bleeding

severe adverse events of anticoagulant medication

major bleeding, anaphylaxis

antiplatet medications

asipirin

ADP receptor blockers

glycoprotein IIB/IIA receptor antagonist

drug for intermittent claudication

ADP receptor blockers drugs

clopidogrel

glycoprotein IIB/IIA receptor antagonist

available only in IV formulation

drugs for intermittent claudication

cilostazol

thrombolytic drug function

digest/dissolve existing clot. MUST be given within 4 hours of clot formation

where are thromoblytics used

in hospital settings since they are all given via IV and serious internal hemmorhage can result

when are thrmobolytics typically used

acute MI, acute ischemic stroke, acute pulmonary embolism

drugs in thrombolytic class

streptokinase, alteplase (activate)

hemostatic function

shorten bleeding time. enhance stability of firing clots and are used to treat severe bleeding from surgical sites.

what drugs are used to control bleeding from routine procedures in patients with hemophilia

hemostatic

drugs in hemostatic class

desmopressin

rhinitis

rhin refers to nose/nasal cavity and it is refers to inflammation

treatment of allergic rhinitis

H1 receptor antagonist'

mast cells stabalizers

intranasal corticosteroids

nasal decongestants (sympathomimetics)

anticholinergics

first generation H1 receptor antagonist-antihistamines drugs

diphenhydramine

common side effects of first and second generation H1 receptor antagonist-antihistamines

dry mouth, dizziness, drowsiness

serious adverse events of first and second gen - H1 receptor antagonist-antihistamines

sedation, paradoxical reaction

second generation H1 receptor antagonist drugs

cetirizine, loratadine, fexofenadine

first and second generation H1 receptor antagonist are used for

acute symptoms and prevention

OTC antihistamine combinations

clorpheniramine w/ phenylephrine

chlorpheniramine w/ pseudoephedrine

diphenhydramine w/ phenylephrine

brompheniramine w/ phenylephrine

chlorpheniramine w/ pseudoephedrine

chlor-trimeton allergy/decongestant

chlorpheniramine w/ phenyleprhine

acifed triaminic, Tylenol allergy multi system gels (also contains acetaminophen)

diphenhydramine w/ phenylephrine

Benadryl allergy/cold