Term
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Definition
prototype drug
side effects: headache, GI complaints (cramping, diarrhea, and constipation)
adverse effects: rhabdomyolysis and liver damage (rare)
contraindications: serious liver disease
nursing considerations - can increase level of digoxin by 20% |
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Term
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Definition
AKA Bile Acid Sequestrant
bind bile acids, increasing the excreation of cholesterol in the stool
large in size = not reabsorbed
capable of producing a 20% drop in LDL
ofetn combined with statins (lowers blood cholesterol by inhibiting HMG-CoA reductase inhibitors)
cause more frequent side effects than statins
can cause bloating and constipation |
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Term
| Cholestyramine (Questran) |
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Definition
prototype drug
side effects: abdominal discomfort, constipation, nausea
contraindications: total bilary obstruction
nursing considerations - can bind to other drugs, interfering with absorption including digoxin, thyroid hormone, and thiazide diuretics
monitor labs: liver enzymes, coagulation studies
mix with liquid and have the patient drink immediately to prevent irritation or obstruction in the GI tract
give other drugs more than 2 hours before or 4 hours after this drug |
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Term
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Definition
B-complex vitamin used to lower VLDL, which in turn lowers LDL
can reduce LDL by about 20%
reduce triglycerides and increase HDL
often used in combination with a statin or bile acid-binding agent
available OTC for vitamin uses, instruct pt ro take this under medical supervision when taking it to lower lipids |
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Term
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Definition
high incidence of adverse reaction compare to Statins
frequent flushing and hot flashes (reduce with intake of aspirin)
do not use with pt with DM (can raise fasting BS)
can cause liver failure and gouty arthritis |
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Term
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Definition
use in combination with Statins
mechanism of action unknown
drug of choice for severe hypertriglyceridemia
a greater decrease in triglyceride levels noted when taken with a statin |
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Term
| Prototype drug: Gemfibrozil (lopid) |
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Definition
up to a 50% reduction in VLDL and an increase in HDL
less effective than statins in lowering LDL
adverse effects: GI related mostly (dyspepsia, diarrhea, nausea, and cramping); may increase likelihood for gallstones; and may affect liver function |
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Term
| nursing considerations (Gemfibrozil) |
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Definition
may potentiate anticoagulant effects when given with oral anticoagulants
may increase effects of certain diabetic agents
monitor LFTs and glucose levels for increases; may decrease hemoglobin, hematocrit, and WBC count
fatty foods may decrease the efficacy of the drug
administer with meals |
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Term
| Cholesterol Absorption inhibitors |
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Definition
newer class
inhibits the absorption of cholesterol
Ezetimibe (Zetia) is the only drug in this class
when given alone, LDL reduction is about 20% -- when adding a statin, LDL reduction is about 35-40%
Vytorin is a combination pill of ezetimibe and a simvastatin (Zocor)
do not give these drugs with a bile acid sequestrant |
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Term
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Definition
Daily weight
Intake and output
Urine oupput
Response of BP
Electrolytes
Take Pulses
Ischemic Episodes (TIA)
Complications : 4 C's -- CAD, CRF, CHF, CVA |
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Term
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Definition
primary, idiopathic, hypertension accounts fro 90% of cases
secondary hypertension -- Cushing's Syndrome, Hyperthyroidism, Chronic renal disease, Certain medications
Consequences - affects the brain, heart, kidneys, and retina |
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Term
| nonpharmacologic management |
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Definition
maintain optimum weight (MOST IMPORTANT)
limit intake of alcohol
restrict sodium intake
reduce intake of saturated fat and cholesterol and increase consumption of fresh fruits and vegetables
increase aerobic physical activity
discontinue use of tobacco and caffeine products
reduce stress and implement coping strategies |
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Term
| selection of antihypertensive drugs |
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Definition
goal is to reduce the morbidity and mortality
individualized to the pt's risk factors, other medical conditions, and degree of HTN
start with a thiazide diuretic for mild to moderate HTN as recommended by the JNC-7
add a second drug if the patient doesn't respond to the initial medication
combination drugs are available -- the benefit is due to additive or synergistic blood pressure reductions |
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Term
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Definition
thiazides are the major diuretic used for treatment of HTN
potassium-sparing diuretics are useful in that they don't deplete potassium but there is potential for hyperkalermia which can lead to dysrhythmias
loop diuretics are not ideal for HTN, except in severe cases |
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Term
| Hydrocholorothiazide (Microzide) |
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Definition
drug prototype for thiazide diuretics
adverse effects: electrolyte imbalance (hypokalemia and hyponatremia)
contraindications - pre-eclampsia or pregnancy induce HTN
nursing considerations - give early in the morning, monitor electrolyte imbalance |
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Term
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Definition
block calcium channels and inhibit calcium from entering the cells
use to treat HTN and cardiovascular disease
at low doses, relaxes smooth muscle, lowering peripheral resistance and decreasing BP
not use a monotherapy
Cleviprex and Cardene - used to treat serious, life-threatening HTN |
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Term
| prototype drug: nifedipin (Adalat, Procardia) |
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Definition
adverse effects: vasodilation (headache, dizziness, peripheral edema, and flushing), rebound tachycardia, and rebound hypotension
nursing considerations - may increase serum levels of Digoxin
use with a beta blocker can increase the risk of CHF
give pills whole, do not crush, chew or break
do not give immediate-release preparations to those with suspicion for MI or within 2 weeks following MI |
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Term
| ACE inhibitors and angiotensin receptor blockers |
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Definition
ACE inhibitors block the effects of angiotensin II
adverse effects: persistent dry cough, hyperkalemia, and angioedema
usually combined with thiazides to enhance the effects
Angiotensin II receptor blockers (ARBs) block actions of angiotensin II after it is forms
fewer adverse effects; no dry cough and even less angioedema
aldosterone receptor blockers: Spironolactone (Aldactone) and epierenon (Inspra) |
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Term
| prototype drug: Enalapril (Vasotec) |
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Definition
may be used as monotherapy or in combination --prolonged half life so minimal daily dosing
adverse effects: hyperkalemia, orthostatic hypotension, headache, angioedema, and cough
nursing considerations - may produce a first-dose phenomenon resulting in profound hypotension, which may result in syncope |
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Term
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Definition
beta-adrenergic blockers --
first line drugs for treatment of HTN
decrease HR and contractility resulting in reduce CO and lower systemic BP
adverse effects rare at LOW DOSES; as it increases, beta blockers will slow HR and cause bronchoconstriction, fatigue, activity intolerance, and impotence (in men)
need to be tapered over several weeks
ex. Metoprolol, Atenolol, Esmolol (beta 1 selective)
alpha-adrenergic blockers (selective alpha-1) --
not first line drugs for HTN
lower BP directly by blocking sympathetic receptors causing vasodilation
usually used concurrently with other drugs, such as diuretics
side effects: Orthostatic hypotension, dizziness, nausea, nervousness, and fatigue
ex. Doxazosin (Cardura) and Prazosin (Minipress) and Tamsulosin (Flomax)
Alpha2-adrenergic agonists --
rarely used
decrease the outflow of cympathetic nerve impulses from CNS to the heart and arterioles causing vasodilation
side effects: sedation, dizziness, and other CNS effects
adverse effects (rare): hemolytic anemia, leukopenia, thrombocytopenia, and lupus
methyldopa - preferred agent for pregnancy induced HTN |
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Term
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Definition
drug prototype for alpha1-adrenergic blocker
adverse effects: orthostatic hypotension, dizziness, and headache
nursing considerations - monitor closely fro profound hypotension and syncope with first few doses
do not split, crush, or chew Cardura XL |
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Term
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Definition
direct relaxation of vascular smooth muscle
produce too many adverse effects; so not drug of first choice -- relax tachycardia, sodium and water retention
nitroprusside (Nitropress) -- drug of choice for hypertensive emergency when there is evidence of target-organ damage, reduces BP in minutes, monitor to not decrease BP too quickly |
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Term
| prototype drug: hydralizine (apresoline) |
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Definition
adverse effects: headache, reflex tachycardia, palpitations, flushing, nausea, diarrhea, sodium and fluid retention
contraindications: angina, rheumatic heart disease, MI, or tachycardia
nursing considerations - tolerance can develop and a dosage increase may be necessary,abrupt withdrawal can cause rebound hypotension and anxiety |
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Term
| etiology of heart failure |
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Definition
most common and fatal of the cardiovasuclar diseases
inability of the ventricles to pump enough blood to meet the body's metabolic demands
this process can be accelerated by many diseases
NO CURE...so the key is prevention, treating, and removing underlying causes |
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Term
| cardiovasuclar changes in the heart |
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Definition
CO - amount of blood pumped by each ventricle per minute
Preload - Degree to which the myocardial fibers are stretched during contraction of the heart
Contractility - strength of contraction of the heart
Inotropic effect - a change in the contractility of the heart, may be positive or negative
Afterload - degree of pressure on the aorta that must be overcome for blood to be ejected from the left ventricle |
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Term
| left vs right sided heart failure |
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Definition
left sided heart failure - most common, excess blood accumulation in the L ventricle causing it to thicken and enlarge (hypertrophy), this will eventually cause back up of blood in the lungs
right sided heart failure - can occur simultaneously or independently of the left side, blood backs up in the the veins
when the heart cannot handle the workload, cardiac decomposition occurs |
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Term
| treatment with ACE inhibitors and ARBs |
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Definition
ACE actions - lower peripheral resistance, inhibits aldosterone secretion, dilates the veins, pts experience fewer HF-related symptoms, hospitalizations, and treatment failures
ARBs actions
similar to those of the ACEs in terms of inhibiting angiotensin, equal in efficacy as ACE when treating HF |
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Term
| Prototype drug: lisinopril (Prinivil) |
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Definition
inhibits angiotensin-converting enzyme and decreases aldosterone secretion
side effects: cough, headache, dizziness, OH, rash, hyperkalemia
adverse effects: chest pain and angioedema
contraindications - hyperkalemia, pregnancy, prior experiences of angioedema from ACE
nursing considerations - cautious use with those taking potassium-sparing diuretics
cautious monitoring when given with other antihypertensive drugs and diuretics
avoid excessive intake of K rich foods
measure BP prior to taking the drug
may take 2-3 weeks for therapeutic effectiveness and possibly several months for heart function to return to normal |
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Term
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Definition
common drugs for treatment of HF, only when fluid retention is present, due to few adverse effects
effective at increasing urine flow
rarely used alone
usually loop diuretics (Furoseimde) are used due to acting quickly and their efficacy at removing fluid
Thiazides can be used but are not as effective -- used for mild-moderate HF
spironolactone is the only potassium-sparing used due to blocking effects of aldosterone on the heart |
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Term
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Definition
prevents reabsorption of Na and Cl
particularly beneficial when cardiac output and renal flow are diminished
side effects: hypokalemia, dehydration
contraindicated - severe fluid/electrolyte depletion
nursing considerations - monitor for signs and symptoms of hypokalemia, should be cautiously monitored in those taking digoxin, potassium-depleting drugs, and corticosteroids |
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Term
| treatment with cardiac glycosides |
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Definition
cause the heart to beat more forcefully and more slowly resulting in improve cardiac output
produces symptomatic improvement
does not reduce mortality from HF
narrow margin of safety
digitalization |
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Term
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Definition
inhibits sodium from being pumped out by enzymes, which causes Ca ions to be released
benefits - increase the contractility or strength of myocardial contraction
adverse effects: dysrhythmias, hypokalemia, fatigue, and visual disturbances
contraindications - AV block and ventricular dysrhythmias
cautious use in - older adults, renal impairment, MI, and hypothyroidism
nursing considerations - cause hypokalemia and cause dysrhythmias
interact with multiple medications
can cause additive bradycardia if given with beta blockers
take the apical pulse for one minute prior to giving the drug.
check digoxin levels frequently |
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Term
| treatment with beta-adrenergic blockers (Antagonists) |
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Definition
only 2 are approved from treatment of heart failure: Coreg and Toprol-XL
block cardiac actions, thus slowing HR and reducing BP
Has a negative inotropic effect
rarely used as monotherapy |
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Term
| Metroprolo (Lopressor, Toprol-XL) |
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Definition
adverse effects: generally minor; slowing of the heart rate, hypotension, drowsiness and insomnia
contraindications - asthma, sinus bradycardia, heart black greater than first degree, and cardiac failure
nursing considerations - assess pulse and BP prior to administration, hold if apical pulse is <60
do not crush or chew sustained-release tablets
treatment for overdose: Atropine to reverse bradycardia, vasopresson (ex. Dopamine) for hypotension |
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Term
| treatment with vasodilator |
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Definition
relax blood vessels and lowers BP
2 primary drugs: Hydralazine (Apresoline) and isosorbide dinitrate (Isordil) are given together for treatment of HF only
very limited because it can cause severe hypotension |
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Term
| treatment with Phosphodiesterase 5 inhibitors |
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Definition
used for short term control of acute HF for those who don't respond to ACE inhibitors or cardiac glycosides -- highly toxic
blocks phosphodiesterase, increasing calcium available for myocardial contraction -- positive inotropic action, vasodilation, improved cardiac output |
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Term
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Definition
preferred drug for this class due to fewer side effects
rapid onset of action -- only administered IV
adverse effects: ventricular dysrhythmias and hypotension
cauious use in those with preexisting dysrhythmias |
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