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[h]

Cardiac Meds

[q] digoxin overview

[a] Increases force of myocardial contraction, decreases heart rate

[q] Digoxin Side Effect

[a] HAD DNV : Halo (visual disturbances), Anorexia, Dizziness, Diarhea, Nausea, Vomiting

[q] Digoxin Adverse reaction

[a] Dysrhythmias, Cardiac Toxicity: Monitor pulse rate, Therapeutic serum levels 0.5 to 2.0 ng/mL, Avoid hypokalemia,

[q] Digoxin Nursing Notes

[a] Check pulse rate and rhythm before administration of digoxin and record. Hold if less than 60/min in an adult, less than 70/min in children, and less than 90/min in infants. Observe for manifestations of hypokalemia, such as muscle weakness,

[q] Digoxin Toxicity Intervention

[a] Stop Digoxin and potassium-sparing medication,Maintain normal K level, Treat Dysrhythmia with lidocaine, Treat bradycardia with atropine.For excessive overdose, activated charcoal, cholestyramine, or Digibind to bind and prevent further absorption

[q] Adrenergic Agonists for Heart Failure

[a] Epinephrine, Dopamine, Dobutamine, Terbutaline : Vasoconstriction and increases BP, HR, Bronchodialtion and makes breathing easier

[q] Adrenergic Agonists side effects

[a] hypertensive crisis, dysrhythmias

[q] Adrenergic Agonists Nursing notes

[a] administered IV by continuous infusion (IV pump), Dosage is titrated based on blood pressure, Dopamine Extravasation can lead to necrosis,

[q] Nitroglycerin

[a] Dilates veins and decreases venous return, decreases cardiac oxygen demand, reduces coronary artery spasm

[q] Nitroglycerin Adverse Effect

[a] Headache, Orthostatic hypotension, Reflex tachycardia, Tolerance

[q] Nitroglycerin Nurse Notes

[a] Vital signs, Ask about use of sildenafil [Viagra], tadalafil [Cialis], vardenafil (might result in severe hypotension), S/L and spray- rapid-acting give at the first sign of chest pain,

[q] S/L nitro notes

[a] Take first tab at onset of pain, if pain not relived in 5 mts, call emergency and take second tab, if pain persists after 5 more minutes, take 3rd tab. Dont take more than 3. Place the tablet under the tongue and allow it to dissolve, Tablets should be stored in original bottles, and in a cool, dark place.

[q] Transdermal Nitroglycerin (patch)

[a] Patches should not be cut, Place the patch on a hairless area of skin -chest, back, or abdomen- rotate sites. Remove old patch, wash skin with soap and water, and dry thoroughly before applying new, Be medication-free between 10 and 12 hr/day.

[q] Nitroglycerin Ointment

[a] Slow onset, Remove the prior dose before a new dose is applied, Apply to a clean, hairless area of the body, and cover with clear plastic wrap, Avoid touching ointment with the hands

[q] Ranolazine – Antianginal

[a] Lowers cardiac oxygen demand, improves exercise tolerance and decreases pain

[q] Ranolazine Adverse Effect

[a] QT prolongation,Elevated blood pressure. Contraindicated in clients who have liver dysfunction

[q] Anti dysrhythmia Meds

[a] Sodium channel blockers (Procainamide, Lidocaine, Propafenone) , Potassium channel blockers (Amiodarone), Calcium channel blockers (Verapamil), Beta-adrenergic blockers (Propranolol), Adenosine, Digoxin

[q] Adenosine

[a] Decrease electrical conduction through AV node

[q] Procainamide Adverse Effect

[a] Hypotension, Systemic lupus syndrome (fever, painful and swollen joints, butterfly-shaped rash on face), Neutropenia and thrombocytopenia, Cardiotoxicity (Widened QRS, increased QT, PR)

[q] Therapeutic procainamide level

[a] 4 to 8 mcg/mL

[q] Lidocaine Adverse Effect

[a] CNS effects (drowsiness, altered mental status, paresthesias, seizures), Respiratory arrest

[q] Propafenone Adverse Effect

[a] Bradycardia, heart failure, dizziness

[q] Propranolol Adverse Effect

[a] Hypotension, bradycardia, heart failure, fatigue

[q] Amiodarone Adverse Effect

[a] Pulmonary toxicity (adverse effects may continue even after stopping med, Obtain baseline chest x-ray and pulmonary function tests), Sinus bradycardia and AV block (Monitor blood pressure, ECG, S/S of Heart failure) , Visual disturbances (photophobia, blurred vision, may lead to blindness), liver and thyroid dysfunction; GI disturbances, CNS effects. Phlebitis with IV administration

[q] Verapamil Adverse Effects

[a] Bradycardia, hypotension, heart failure (report s/s) ,constipation, orthostatic hypotension (change positions slowly)

[q] Adenosine Side Effect

[a] hypotension, dyspnea, bradycardia, flushing of face

[q] Adinosine Notes

[a] Very short half-life (Give fast IV, flushed with saline after, give through central line-close to heart if possible)

[q] Lidocaine nursing note

[a] IV start with a loading dose, maintenance dose of 1 to 4 mg/min, dont use for no more than 24 hr

[q] Cholesterol Lowering Meds

[a] “Statin”: Atorvastatin, Simvastatin, Lovastatin, Pravastatin, Rosuvastatin, Fluvastatin :

[q] Statin adverse Effects

[a] Hepatotoxicity (Monitor liver function tests), Myopathy/Rhabdomyolysis (Monitor CK levels)

[q] Statin Nurse Notes

[a] Notify Muscle aches, pain, and tenderness, observe for indications of liver dysfunction (anorexia, vomiting, nausea, jaundice). Teach to take in the evening, avoid grapefruit juice

[q] Ezetimibe

[a] Inhibits absorption of cholesterol

[q] Ezetimibe side effect

[a] Hepatiis and Myopathy

[q] Colesevelam, Colestipol

[a] Bile Acid Sequestrants – decrease in LDL cholesterol

[q] Bile Acid Sequestrants Side effect

[a] Constipation (increase the intake of high-fiber food and oral fluids), Reduced absorption of other meds (take other medications 4 hr before)

[q] Colestipol and food

[a] Colestipol – Give 30 min before a meal. If powder form – use an adequate amount of fluid to dissolve to avoid impaction of the esophagus

[q] Niacin/Nicotinic Acid

[a] decrease in LDL cholesterol and triglyceride levels

[q] Niacin/Nicotinic Acid Side Effect

[a] GI distress, Facial flushing, Hyperglycemia, Hepatotoxicity, Hyperuricemia

[q] Gemfibrozil, Fenofibrate

[a] Decrease in triglyceride levels, Increase in HDL levels

[q] Gemfibrozil, Fenofibrate Side Effect

[a] GI distress (take medication 30 min prior to breakfast and dinner) Gallstones (watch for RUQ pain, fat intolerance, bloating), Myopathy (Monitor for muscle aches, pain, and tenderness,CK level), Hepatotoxicity

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