Cardiology Pt 1

Lisniopril class

ACE inhibitor

Lisniopril treat

HTN, heart failure, diabetic nephropathy, L ven. dysfunction

Lisinopril adverse

Hypotension --> in pts who have HTN, taking diuretics, or on sodium restricted diets

Common: rash, metallic taste, dry non-productive cough, (increased level of bradykinin)

Lisinopril intervention

monitor BP, dry cough, angioedema

Lisinopril teaching

give orally

lie supine if hypotension occurs

do not take if pregnant/breastfeeding

Lisinopril caution in what pts?

BMS, immunosuppression meds, autoimmune disorder, African Americans (less effective and increased risk of angioedema)

Lisinopril labs to monitor

Increased potassium and decreased sodium

WBC and C4 count

Losartan class

Angiotensin II receptor blocker (ARBs)

Losartan treat

HTN, prevent stroke, manage diabetic nephropathy, prevent migraine and headaches

antihypertensive effect (2nd choice)

Losartan adverse

angioedema, dizziness, hypotension, headache, and insomnia

Losartan intervention

monitor BP and adverse effects

Losartan teaching

Give orally

monitor for swelling of mouth

do not take if pregnant/breastfeeding

NSAIDs can decrease effectiveness

Amlodipine class

Calcium channel blocker

Amlodipine treat

None and dihydropyridine HTN

Nondihy- cardiac dysrhythmias

angina

Amlodipine adverse

reflex tachycardia

drop in BP

Headache, lightheadedness, dizziness, facial flushing, arrythmias, gingival hyperplasia

Amlodipine intervention

Monitor HR and BP closely

promote good dental hygiene check-ups

Amlodipine teaching

give orally and extended tablets

DO NOT crush or chew

Avoid grapefruit and it's juice

Metoprolol class

Beta Blocker

Metoprolol treat

decrease BP through heart (HR and contractility) and kidneys (through renin)

Metoprolol adverse

Bradycardia, heart failure --> SOB, edema, coughing

SUDDEN WITHDRAWAL = rebound excitation = tachycardia = anginal pain or MI

Metoprolol intervention

Monitor HR and BP before administering

Metoprolol given with digoxin

increase bradycardia

Metoprolol if given with antacids

decrease absorption

Metoprolol if given with oral hypoglycemic agents

increase risk for hypoglycemia

Metoprolol teaching

oral and IV, any sustained must not be crushed

Take pulse before administering

Do not give if pt has cardiogenic shock

Clonidine class

Centrally acting Alpha2 agonist

Clonidine treat

HTN, severe pain, ADHD

Activated alpha2 receptors = sns stimulation of the heart = reduces BP

Clonidine adverse

drowsiness, dizziness, dry mouth, rebound hypersensitive if stopped abruptly

Clonidine intervention

Monitor CNS effect

Dry mouth will decrease (suck on hard candy or sip water )

Ensure dose is tapered

Clonidine teaching

Do not give if on coagulant med

Carvedilol class

Aplha/Beta blocker

Carvedilol treat

HTN and heart failure can improve survival of MI

Carvedilol action

Block alpha and beta receptors = decrease rate and contractility and renin = decreased CO and increase of water and sodium

Carvedilol adverse

Dizziness, hypotension, bradycardia, reduced CO, postural hypotension, exacerbation of asthma

Carvedilol intervention

check HR and BP before

Carvedilol given with hypoglycemic meds will...

alter effectiveness of the hypoglycemic medication

Carvedilol given with digoxin will...

raise risk for bradycardia

Carvedilol given with MOAIs will...

bradycardia and hypotension

Carvedilol given with cimetidine

increase blood levels of alpha/beta blockers

Carvedilol teaching

Oral only

Move slowly to prevent falls

Hydralazine class

direct acting vasodilator

Hydralazine treat

decreasing preload and afterload to treat HTN, heart failure, pulmonary HTN, and angina

Hydralazine adverse

reflex tachycardia, dizziness, weakness, fatigue, headache

Fluid retention and edema

Hydralazine high dosage will cause...

systemic lupus erythematosus-like reaction

Hydralazine intervention

Dosing will start low to reduce effects

Use with caution in patients with renal/heaptic impairment

NSAIDs do what when combined with Hydralazine?

decrease effectiveness

Hydralazine given in what forms

Oral, IM, or IV

Furosemide (LASIXS) class

Loop diuretic

Furosemide treat

heart failure, increases urine output and K+ excretion

Furosemide adverse

Electrolyte imbalances (Na+, Cl-, and K+)

Dehydration, orthostatic hypotension, ototoxicity, hyperglycemia

Increased uric acid = GOUT

Furosemide interventions

Monitor electrolytes

monitor BP (with position changes)

Furosemide given in what forms

Orally, IM, IV --> Give IV forms undiluted and administer slowly to prevent ototoxicity

Furosemide contraindicated in what pts

Hepatic coma, urania, electrolyte imbalance, dehydration

Use Furosemide in pts with

renal/hepatic disorders or diabetes mellitus

Hydrochlorothiazide class

Thiazide diuretics

Hydrochlorothiazide treats

Heart failure, HTN, cirrhosis of the liver, renal failure

Hydrochlorothiazide adverse

fluid and electrolyte imbalances, hyperglycemia, gouty arthritis

Hydrochlorothiazide intervention

Adequate kidney perfusion and GFR

Monitor serum electrolyte

Monitor blood glucose and uric levels

Hydrochlorothiazide electrolyte imbalance signs

muscle twitching, weak pulse, nausea, and dysrhythmias

Hydrochlorothiazide teaching

dose by 1500 to prevent nocturia

eat food rich in K+

risk for digoxin toxicity if Mag and K+ deficiency

Spironolactone class

Potassium sparing diuretic

Spironolactone treat

bocking aldosterone --> increase excretion of Na+ and decreases K+

The increase in urine is minimal (not a strong diuretic)

Spironolactone adverse

Hyperkalemia

Steroid --> menstrual irregularities, abnormal hair growth, growth of breat tissue in men and impotence

Spironolactone intervention

Monitor serum K+ levels

Hyperkalemia = cardiac dysrhythmias

Spironolactone teaching

give orally with food

tell pt to report signs of hyperkalemia

DO NOT take if pregnant

Digoxin class

cardiac glycoside

Digoxin treat

Ca+ collect in heart --> increase contractility --> increase kidney perfusion = decrease in vasoconstriction and HR

Digoxin adverse

cardiac dysrhythmias, halos around dark objects or yellow tinge to vision

Digoxin intervention

Monitor for vomiting = decrease in K+ = increase digoxin toxicity

Monitor dysrhythmias

Take apical pulse for a FULL MINUTE before giving

Digoxin antidote

Digoxin immune FAB or digibind

Digoxin teaching

IV given over 5 minute, monitor for infiltration

Report signs of hypokalemia (muscle weakness)

Dobutamine class

Sympathomimetic

Dobutamine treat

heart failure (increasing contractility and kidney perfusion)

Dobutamine adverse

Tachycardiac, cardiac dysrhythmias, possible anginal pain

Dobutamine intervention

cardiac rhythm and vitals

Dobutamine teaching

IV dosed based on pt weight

DO NOT give to pts who are dehydrated

Dobutamine given with what cause toxicity

MOAIs and tricyclic antidepressants

Milrinone class

phosphodiesterase inhibitor

Milrinone treat

long and short term heart failure management, increases contractility

Milrinone adverse

ventricular dysrhythmias, hypokalemia, hypotension, anginal pain

Milrinone intervention

Correct hypokalemia before giving monitor VS and cardiac rhythm

Milrinone teaching

Give IV over 10 minutes

Report chest pain

Milrinone contraindicated in pts with...

aortic or pulmonary valve disorders

Milrinone use with caution in pts with Hx of...

renal impairment, Hx of arrhythmias, electrolyte imbalances, or abnormal digoxin levels

Sacubitril/Valsartan class

Angiotensin receptor neprilysin inhibtor (ARNI)

Sacubitril treat

prevents natriuretic peptide breakdown

Valsartan treat

lowers BP by blocking angiotensin II receptors

Sacubitril/Valsartan adverse

hyperkalemia, kidney failure, hypotension, cough

Sacubitril/Valsartan intervention

Monitor BP, renal, K+, urine output, signs of heart failure

Sacubitril/Valsartan teaching

If on ACE inhibitors must wait 36 hours to take to prevent allergic reaction

Sacubitril/Valsartan cannot be taking concurrently with what?

ACE inhibitor

Epinephrine class

adrenergic agonist

Epinephrine treat

Arterial dilation, increase HR and contractility, coronary artery dilation, bronchodilation, and increase glucose levels

Epinephrine adverse

Chest pain, MI, hypertensive crisis

Epinephrine intervention

continuously monitor BP, pulse, RR, lung sounds

Epinephrine teaching

give IM or SUBQ for anaphylaxis