Term
| Drugs in these groups regulate heart contraction, heart rate and rhythm, and blood flow to the myocardium (heart muscle). 3 groups. |
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Definition
| ardiac glycosides, antianginals, and antidysrhythmics |
|
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Term
| ________ began being used as early as 1200 AD, making it one of the oldest drugs. It is still used in a purified form. |
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Definition
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Term
| _____ preparations have come to be known for their effectiveness in treating heart failure |
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Definition
|
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Term
| When the heart muscle (myocardium) weakens and enlarges, it loses its ability to pump blood through the heart and into the systemic circulation. This is called |
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Definition
|
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Term
| When compensatory mechanisms fail and the peripheral and lung tissues are congested, the condition is |
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Definition
| congestive heart failure (CHF) |
|
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Term
| he client has left-sided HF when the left ventricle does not contract sufficiently to pump the blood returned from the lungs ___ ____ ut through the aorta into the peripheral circulation; this causes excessive amounts of blood to back up into the lung tissue. |
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Definition
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Term
| . Usually the client has shortness of breath (SOB) and dyspnea when they have.... |
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Definition
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Term
| ____ ____ ___ ___ occurs when the heart does not sufficiently pump the blood returned into the right atrium from the systemic circulation |
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Definition
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Term
| As a result of ____ ___ ___ ___, the blood and its constituents are backed up into peripheral tissues, causing peripheral edema |
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Definition
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Term
| In the cardiac physiology of HF, there is an increase in ____and ______ |
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Definition
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Term
| An increased preload results from an excess of blood volume in the ____ at the end of the diastole |
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Definition
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Term
| Increased afterload is an additional pressure or force in the ventricular wall caused by excess resistance in the ______ |
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Definition
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Term
| In the early stage of HF, there are ___ symptoms and ____ structural heart damage. |
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Definition
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Term
| Naturally occurring ____ _____ are found in a number of plants, including Digitalis. |
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Definition
|
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Term
| Also called digitalis glycosides, they are a group of drugs that inhibit the ____ ____ ____, resulting in an increase in intracellular sodium. |
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Definition
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Term
| Digitalis preparations have three effects on heart muscle: |
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Definition
| (1) a positive inotropic action (increases myocardial contraction stroke volume), (2) a negative chronotropic action (decreases heart rate), and (3) a negative dromotropic action (decreases conduction of the heart cells) |
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Term
| The increase in myocardial contractility strengthens cardiac, peripheral, and kidney function by enhancing ___ ____, decreasing ____, improving ___ ___ to the periphery and kidneys, decreasing edema, and promoting fluid excretion. |
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Definition
| cardiac output, preload, blood flow |
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Term
| Digoxin does not prolong life. It acts by increasing the force and velocity of myocardial _______ contraction. |
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Definition
|
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Term
| First-line drugs used to treat acute HF include: |
|
Definition
| inotropic agents (dopamine and dobutamine) and phosphodiesterase inhibitors (inamrinone [Inocor], formerly known as amrinone, and milrinone [Primacor]) |
|
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Term
| stage 2 HF characteristics |
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Definition
| Some level of cardiac changes, e.g., decreased ejection fraction without symptoms of HF. |
|
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Term
| stage 3 HF characteristics |
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Definition
| Structural heart disease with symptoms of HF, i.e., fatigue, shortness of breath, edema, and decrease in physical activity. |
|
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Term
| stage 4 HF characteristics |
|
Definition
| Severe structural heart disease and marked symptoms of HF at rest. |
|
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Term
| cardiac dysrhythmia with rapid uncoordinated contractions of atrial myocardium |
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Definition
|
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Term
| cardiac dysrhythmia with rapid contractions of 200 to 300 beats/min |
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Definition
|
|
Term
| decreased conduction through the atrioventricular [AV] node |
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Definition
| negative dromotropic effects |
|
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Term
| decreases heart rate is a result of what effect |
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Definition
| negative chronotropic effects |
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Term
| For management of atrial fibrillation, a____ ____ blocker, such as verapamil (Calan) may be prescribed. |
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Definition
|
|
Term
| pharmacological ways to treat HF |
|
Definition
| limit salt, avoid or severely limit alchohol, quit smoking, lose weight, exercise |
|
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Term
| An elevated ____ ____ horomone or peptide (ANP) may confirm |
|
Definition
| Atrial Natriuretic Hormone |
|
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Term
| is secreted from the atria of the heart and acts as an antagonist to renin and aldosterone. It is released during expansion of the atrium, produces vasodilation, and increases glomerular filtration rate. |
|
Definition
| Atrial Natriuretic Hormone |
|
|
Term
| the average range of ANH (Atrial Natriuretic Hormone) is : |
|
Definition
| 20 to 77 pg/mL; 20 to 77 ng/L (SI units) |
|
|
Term
| average (reference) values of Brain Natriuretic Peptide |
|
Definition
| Desired value: less than 100 pg/mL; positive value: greater than 100 pg/mL |
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Term
| The brain natriuretic peptide (BNP) is primarily secreted from____ ____ cells and when tested, aids in the diagnoses of HF. |
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Definition
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Term
| An elevated ___ ___ ___ helps to differentiate that dyspnea is due to HF rather than lung dysfunction. |
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Definition
| BNP Brain Natriuretic Peptide |
|
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Term
| Frequently the BNP is higher than 100 pg/mL in ____ who are ____ years or older. An 80-year-old woman may have a BNP of 160 pg/mL. However, the BNP is markedly higher (i.e., 400 pg/mL) in HF. |
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Definition
|
|
Term
| serum level of digoxin (therapeutic range: |
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Definition
|
|
Term
Do not confuse...
• digoxin with digitoxin. Both drugs are cardiac glycosides. Digoxin (Lanoxin) is usually the first-choice drug, because its half-life is ______, whereas the half-life of digitoxin is ________days. Digitoxin is rarely prescribed. |
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Definition
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Term
| ______ percent of digoxin is metabolized by the liver, and 50% to 70% is excreted by the kidneys mostly unchanged. |
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Definition
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|
Term
| _______ is a potent cardiac glycoside that has a very long half-life (5 to 14 days) and is highly protein-bound (97%) |
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Definition
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|
Term
| In clients with a failing heart, cardiac glycosides ______ myocardial contraction, which ______cardiac output and improves circulation and tissue perfusion. Because these drugs decrease conduction through the AV node, the heart rate _______ |
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Definition
| increases, increases, decreases |
|
|
Term
| DIGoxin contraindications |
|
Definition
| Ventricular dysrhythmias, second- or third-degree heart blockCaution: AMI, renal disease, hypothyroidism, hypokalemia |
|
|
Term
|
Definition
| Anorexia, nausea, vomiting, diarrhea, headache, blurred vision (yellow-green halos), diplopia, photophobia, drowsiness, fatigue, confusion |
|
|
Term
| digoxin adverse reactions |
|
Definition
Bradycardia, visual disturbances
Life-threatening: Atrioventricular block, cardiac dysrhythmias |
|
|
Term
| he onset and peak actions of oral and intravenous (IV) digoxin vary. The therapeutic serum level is 0.5 to 2.0 ng/mL for digoxin. To treat HF, the _____serum therapeutic levels should be obtained, and for atrial flutter or fibrillation, the ______ therapeutic serum levels are required. |
|
Definition
|
|
Term
| Digitalis (Digoxin) Toxicity |
|
Definition
| anorexia, diarrhea, nausea and vomiting, bradycardia (pulse rate below 60 beats/min), premature ventricular contractions, cardiac dysrhythmias, headaches, malaise, blurred vision, visual illusions (white, green, yellow halos around objects), confusion, and delirium |
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Term
| Cardiotoxicity is a serious adverse reaction to |
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Definition
|
|
Term
| _______ may be given to treat severe digitalis toxicity |
|
Definition
| Digoxin immune Fab (ovine, Digibind |
|
|
Term
| ______ increases the effect of digoxin at its myocardial cell site of action, resulting in digitalis toxicity |
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Definition
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|
Term
| _________ preparations taken systemically promote sodium retention and potassium excretion or loss and can also cause hypokalemia |
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Definition
|
|
Term
| his drug group inhibits the enzyme phosphodiesterase, promoting a positive inotropic response and vasodilation. The two drugs in this group are inamrinone lactate (Inocor) and milrinone lactate (Primacor). |
|
Definition
| Phosphodiesterase Inhibitors |
|
|
Term
| hese drugs increase stroke volume and cardiac output and promote vasodilation. They are administered IV for no longer than 48 to 72 hours. |
|
Definition
| Phosphodiesterase Inhibitors |
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|
Term
| Severe cardiac dysrhythmias might result from the use of_______ _____ , so the client's electrocardiogram (ECG) and cardiac status should be closely monitored. |
|
Definition
| phosphodiesterase inhibitors |
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Term
| _________ decrease venous blood return to the heart resulting in a decrease in cardiac filling, ventricular stretching (preload), and oxygen demand on the heart. |
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Definition
|
|
Term
| he arteriolar dilators act in three ways: |
|
Definition
| to reduce cardiac afterload, which increases cardiac output; (2) to dilate the arterioles of the kidneys, which improves renal perfusion and increases fluid loss; and (3) to improve circulation to the skeletal muscles. |
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Term
| _______ _______ decreases absorption of digoxin and thus decreases serum digoxin level. |
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Definition
|
|
Term
| ______ can potentiate the effect of digoxin. It promotes potassium loss (hypokalemia), which increases the effect of digoxin. It may cause digitalis toxicity. |
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Definition
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|
Term
| ____ ______ dilate venules and arterioles, improving renal blood flow and decreasing blood fluid volume. They also moderately decrease the release of aldosterone, which in turn reduces sodium and fluid retention. |
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Definition
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|
Term
| ACE inhibitors can increase _______ levels |
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Definition
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|
Term
| _______ are the first-line drug treatment for reducing fluid volume. They are frequently prescribed with digoxin or other agents. |
|
Definition
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|
Term
| ____ _____ are used to treat angina pectoris |
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Definition
|
|
Term
| This is a condition of acute cardiac pain caused by inadequate blood flow to the myocardium due to either plaque occlusions within or spasms of the coronary arteries |
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Definition
|
|
Term
| nginal pain is frequently described by the client as |
|
Definition
| tightness, pressure in the center of the chest, and pain radiating down the left arm. |
|
|
Term
| There are three types of angina: |
|
Definition
Classic (stable): Occurs with stress or exertion
• Unstable (preinfarction): Occurs frequently with progressive severity unrelated to activity
• Variant (Prinzmetal, vasospastic): Occurs during rest |
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|
Term
| Unstable angina often indicates an impending... |
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Definition
|
|
Term
| Nonpharmacologic methods of decreasing anginal attacks are to |
|
Definition
| avoid heavy meals, smoking, extremes in weather changes, strenuous exercise, and emotional upset. |
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Term
| _______ drugs increase blood flow either by increasing oxygen supply or by decreasing oxygen demand by the myocardium |
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Definition
|
|
Term
| Three types of antianginal drugs: |
|
Definition
| nitrates, beta blockers, and calcium channel blockers. |
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Term
| The major systemic effect of ______ is a reduction of venous tone, which decreases the workload of the heart and promotes vasodilation. |
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Definition
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Term
| ___ and ____ blockers decrease the workload of the heard and decrease oxygen demands |
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Definition
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|
Term
| ____ and ___ ____ blockers are effective in treating variant (vasospastic) angina pectoris. Beta blockers are not effective for this type of angina. |
|
Definition
| nitrates, calcium channel |
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Term
| ______ cause generalized vascular and coronary vasodilation, which increases blood flow through the coronary arteries to the myocardial cells. |
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Definition
|
|
Term
| This group of drugs reduces myocardial ischemia but can cause hypotension. |
|
Definition
|
|
Term
| Beta blockers are not effective in treating.. |
|
Definition
| VARIANT (VASOSPASTIC) ANGINAS |
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|
Term
| The effects of SL nitroglycerin last for ____ minutes. |
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Definition
|
|
Term
| Nitroglycerin acts directly on the smooth muscle of blood vessels, causing relaxation and dialation. It ________cardiac preload (the amount of blood in the ventricle at the end of diastole) and afterload (peripheral vascular resistance) and ______ myocardial O2 demand |
|
Definition
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|
Term
| The onset of action of nitroglycerin depends on the method of administration. With SL and IV use, the onset of action is rapid (_____ minutes); it is slower with the transdermal method (_____ minutes). The duration of action of the transdermal nitroglycerin patch is approximately ___hours. |
|
Definition
| 1-3 minutes, 30-60 minutes, 24 hrs |
|
|
Term
|
Definition
| Nausea, vomiting, headache, dizziness, syncope, weakness, flush, confusion, pallor, rash, dry mouth |
|
|
Term
| nitrate adverse reactions |
|
Definition
Hypotension, reflex tachycardia, paradoxical bradycardia
Life-threatening: Circulatory collapse |
|
|
Term
| lack of blood supply to the heart muscle is called |
|
Definition
|
|
Term
| ---- ----- decrease the effects of the sympathetic nervous system by blocking the action of the catecholamines (epinephrine and norepinephrine), thereby decreasing the heart rate and blood pressure |
|
Definition
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|
Term
| Beta blockers are effective as antianginals because by _______the heart rate and myocardial contractility, they ______the need for oxygen consumption and consequently ______ anginal pain |
|
Definition
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|
Term
| Beta blockers should not be abruptly discontinued. The dose should be tapered over a specified number of days to avoid ____ _____ |
|
Definition
|
|
Term
| Beta blockers, are subdivided into: |
|
Definition
| nonselective beta blockers (blocking beta1 and beta2) and selective (cardiac) beta blockers (blocking beta1). |
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Term
| The cardioselective beta blockers act more strongly on the beta1 receptor, which decreases the heart rate but avoids bronchoconstriction because of their lack of activity at the ____ receptor. |
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Definition
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|
Term
| Because beta blockers ______the force of myocardial contraction, oxygen demand by the myocardium is ____. Therefore, the client can tolerate _______exercise with less oxygen requirement |
|
Definition
| decrease, reduced, increased |
|
|
Term
| nonselective beta blockers, adverse reactions : |
|
Definition
| bronchospasm, behavioral or psychotic response, and impotence |
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|
Term
| ______ activates myocardial contraction, increasing the workload of the heart and the need for more oxygen |
|
Definition
|
|
Term
| ____ ____ _____ relax coronary artery spasm (variant angina) and relax peripheral arterioles (stable angina), decreasing cardiac oxygen demand. They also decrease cardiac contractility (negative inotropic effect that relaxes smooth muscle), decrease afterload, decrease peripheral resistance, and reduce the workload of the heart, which decreases the need for oxygen |
|
Definition
|
|
Term
| Calcium channel blockers achieve their effect in controlling variant (vasospastic) angina by ______ coronary arteries and in controlling classic (stable) angina by _______ oxygen demand. |
|
Definition
|
|
Term
| The side effects of calcium blockers include |
|
Definition
headache, hypotension, dizziness, and flushing of the skin.
Reflex tachycardia can occur as a result of hypotension. |
|
|
Term
| ________ is contraindicated for marked hypotension or acute myocardial infarction (AMI). |
|
Definition
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|
Term
| _____ ______ is defined as any deviation from the normal rate or pattern of the heartbeat. This includes heart rates that are too slow (bradycardia), too fast (tachycardia), or irregular. |
|
Definition
|
|
Term
| the return of cell membrane potential to resting after depolarization is: |
|
Definition
|
|
Term
| lack of oxygen to body tissues |
|
Definition
|
|
Term
| increased carbon dioxide in the blood |
|
Definition
|
|
Term
| _____ _____ leads to an increased release of intracellular calcium from the sarcoplasmic reticulum, resulting in cardiac contraction. In the presence of myocardial ischemia, the contraction can be irregular. |
|
Definition
|
|
Term
| Cardiac action potentials are transient depolarizations followed by repolarizations of myocardial cells... what are the 5 phases of this: |
|
Definition
| Phase 0 is the rapid depolarization caused by an influx of sodium ions. Phase 1 is initial repolarization, which coincides with termination of sodium ion influx. Phase 2 is the plateau and is characterized by the influx of calcium ions, which prolong the action potential and promote atrial and ventricular muscle contraction. Phase 3 is rapid repolarization caused by influx of potassium ions. Phase 4 is the resting membrane potential between heartbeats. |
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|
Term
| The desired action of ________ drugs is to restore the cardiac rhythm to normal |
|
Definition
| antidysrhythmic (antiarrhythmic) |
|
|
Term
| The antidysrhythmics are grouped into four classes: |
|
Definition
| (1) fast (sodium) channel blockers IA, IB, and IC; (2) beta blockers; (3) drugs that prolong repolarization; and (4) slow (calcium) channel blockers. |
|
|
Term
| A ____ ____ blocker decreases sodium influx into cardiac cells. Responses to the drug are decreased conduction velocity in cardiac tissues; suppression of automaticity, which decreases the likelihood of ectopic foci; and increased recovery time |
|
Definition
|
|
Term
| three subgroups of sodium channel blockers. |
|
Definition
| . IA slows conduction and prolongs repolarization (quinidine, procainamide, disopyramide). IB slows conduction and shortens repolarization (lidocaine, mexiletine HCl). IC prolongs conduction with little to no effect on repolarization (flecainide). |
|
|
Term
| Slow conduction and prolong repolarization is which sodium channel blocker? |
|
Definition
|
|
Term
| ______ ______ decrease conduction velocity, automaticity, and recovery time (refractory period). Examples are propranolol (Inderal), acebutolol (Sectral), esmolol (Brevibloc), and sotalol (Betapace). They are more frequently prescribed for dysrhythmias than sodium channel blockers. |
|
Definition
|
|
Term
| Adverse Reactions for Antidysrhythmic Drugs |
|
Definition
heart block and neurologic and psychiatric symptoms,
cardiovascular depression, bradycardia, hypotension, seizures, blurred vision, and double vision. |
|
|
Term
1. A newly admitted client takes digoxin 0.25 mg/day. The nurse knows that which is the serum therapeutic range for digoxin?
a. 0.1 to 1.5 ng/mL
b. 0.5 to 2.0 ng/mL
c. 1.0 to 2.5 ng/mL
d. 2.0 to 4.0 ng/mL |
|
Definition
|
|
Term
2. The client's serum digoxin level is 3.0 ng/mL. What does the nurse know about this serum digoxin level?
a. It is in the high (elevated) range.
b. It is in the low (decreased) range.
c. It is within the normal range.
d. It is in the low average range. |
|
Definition
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|
Term
3. The nurse is assessing the client for possible evidence of digitalis toxicity. The nurse acknowledges that which is included in the signs and symptoms for digitalis toxicity?
a. Pulse (heart) rate of 100 beats/min
b. Pulse of 72 with an irregular rate
c. Pulse greater than 60 beats/min and irregular rate
d. Pulse below 60 beats/min and irregular rate |
|
Definition
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|
Term
4. The client is also taking a diuretic that decreases her potassium level. The nurse expects that a low potassium level (hypokalemia) could have what effect on the digoxin?
a. Increase the serum digoxin sensitivity level
b. Decrease the serum digoxin sensitivity level
c. Not have any effect on the serum digoxin sensitivity level
d. Cause a low average serum digoxin sensitivity level |
|
Definition
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|
Term
5. When a client first takes a nitrate, the nurse expects which symptom that often occurs?
a. Nausea and vomiting
b. Headaches
c. Stomach cramps
d. Irregular pulse rate |
|
Definition
|
|
Term
6. The nurse acknowledges that beta blockers are as effective as antianginals because they do what?
a. Increase oxygen to the systemic circulation.
b. Maintain heart rate and blood pressure.
c. Decrease heart rate and decrease myocardial contractility.
d. Decrease heart rate and increase myocardial contractility. |
|
Definition
|
|
Term
7. The health care provider is planning to discontinue a client's beta blocker. What instruction should the nurse give the client regarding the beta blocker?
a. The beta blocker should be abruptly stopped when another cardiac drug is prescribed.
b. The beta blocker should NOT be abruptly stopped; the dose should be tapered down.
c. The beta blocker dose should be maintained while taking another antianginal drug.
d. Half the beta blocker dose should be taken for the next several weeks. |
|
Definition
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|
Term
8. The beta blocker acebutolol (Sectral) is prescribed for dysrhythmias. The nurse knows that what is the primary purpose of the drug?
a. To increase the beta1 and beta2 receptors in the cardiac tissues
b. To increase the flow of oxygen to the cardiac tissues
c. To block the beta1-adrenergic receptors in the cardiac tissues
d. To block the beta2-adrenergic receptors in the cardiac tissues |
|
Definition
|
|
