Advanced Pharm for Nursing Practice 4
Help!
|
|
||||
|---|---|---|---|---|---|
| *REMEMBER THAT A DECR IN blood flow and Na+ content causes the release of Renin | show 🗑
|
||||
| show | Aliskiren (Tekturna) is the prototype for Renin Inhibitors
🗑
|
||||
| show | these drugs inhibit renin itself; blocking renin blocks the whole renin-angiotensin-aldosterone mechanism
🗑
|
||||
| What is the indication for using Aliskiren (Tekturna)? | show 🗑
|
||||
| show | they’re best absorbed on empty stomach, they have a ½-life of 24hrs, and once in the bld, it’s not metabolized and is excreted unchanged in the feces
🗑
|
||||
| What are the SE/ADR of renin inhibitors like aliskiren (Tekturna)? | show 🗑
|
||||
| show | *O2 supply: cardiac O2 supply determined by myocardial bld flow. Under resting conditions, t/ heart extracts nearly all O2 delivered to it by the coronary vessels.
🗑
|
||||
| show | stable occlusive: pt is stable w/o exertion; unstable angina: pt is unstable even w/o exertion; vasospastic angina (Prinzmetal’s): variant angina that happens mostly to women under stress (their coronary arteries were NOT occluded)
🗑
|
||||
| *THE ONLY WAY TO ACCOMMODATE AND INCR IN DEMAND IS TO INCR BLOOD FLOW | show 🗑
|
||||
| What are the main drugs used to treat HTN? | show 🗑
|
||||
| show | Nitrates act directly on the smooth muscle cell to release myosin (in t/ actin-myosin contraction) to allow the smooth muscle cell to relax
🗑
|
||||
| What’s the action of nitrates? | show 🗑
|
||||
| show | nitrates are used for t/ tx/prevention of angia pectoris; they can also be used in acute MIs (usually as result of not responding to other drugs). IV nitro is available for acute MI
🗑
|
||||
| show | the main action/prob of nitrates is LARGE 1ST PASS EFFECT; nitrates have short ½-life; if nitrates given sublingually, you bypass 1st pass effect
🗑
|
||||
| What are the 2 diff thoughts for Nitro admin & angina attacks? | show 🗑
|
||||
| Why call an EMS or 911 if having an angina attack instead of self transport? | show 🗑
|
||||
| What are the SE/ADR of nitrates? | show 🗑
|
||||
| What are warnings about nitrates? | show 🗑
|
||||
| What are the ways to administer nitroglycerin? | show 🗑
|
||||
| show | isosorbide mononitrate (ISMO) are drugs very similar to nitrates; it doesn’t have large 1st pass effect, and can be prescribed for 1 or 2x/day to prevent angina attacks
🗑
|
||||
| show | beta-blockers slow the heart rate and decr contractility (inotrope-how strong) which releases workload on heart; beta-blockers do not cause vasodilation
🗑
|
||||
| What are SE/ADR of beta-blockers? | show 🗑
|
||||
| show | DON’T STOP BETA-BLOCKERS ABRUPTLY (remember up regulation)
🗑
|
||||
| What’s the indication for Ca++ Channel blockers? | show 🗑
|
||||
| show | NON-DIHYDROPYRIDINE group (Verapamil), acts on heart to DECR CONTRACTILITY & HEART RATE, Verapamil also has a vasodilating effect; DIHYDROPYRIDINE group (Norvasc) Amlodipine or (Procardia) hv mainly a VASODILATING effect, and no effect on heart
🗑
|
||||
| *All Ca++ channel blockers decr preload and postload | show 🗑
|
||||
| What is Ranolozine (Ranexa), and what is its indication? | show 🗑
|
||||
| What’s the method of action of ranolozine (Ranexa)? | show 🗑
|
||||
| What are SE/ADR of ranolozine (Ranexa)? | show 🗑
|
||||
| show | you want EARLY PERFUSION of coronary vessels, so: O2, heparin, sublingual nitro while prepping IV, and Beta-blocker for tachycardia; tx depends on whether there’s an ST-segment elevation or not
🗑
|
||||
| What is heart failure? | show 🗑
|
||||
| What happens when there is decr bld flow to tissues? | show 🗑
|
||||
| show | the aim of tx in chronic heart failure is to decr sympathetic activity and decr t/ renin-angiotensin-aldosterone systems
🗑
|
||||
| What’s the drug of choice in chronic heart failure? | show 🗑
|
||||
| show | *ONLY ACEIs & beta-blockers are known to improve morbidity and mortality in pts /c heart failure
🗑
|
||||
| show | pts /c CHF hv edema bc of poor cardiac output to kidneys, therefore only loop diuretics (which work with malfunctioning heart) will work in reducing edema; loop diruretics DO NOT IMPROVE MORBIDITY OR MORTALITY
🗑
|
||||
| How does digoxin work on the heart? | show 🗑
|
||||
| Is heart failure a slow of fast developing process? | show 🗑
|
||||
| Reminders of spironolactone (a K+-sparing diuretic) | show 🗑
|
||||
| show | Digoxin (Lanoxin, Digitek)
🗑
|
||||
| show | primary: tx of heart failure if symptoms continue /p use of 1st line drugs; used in atrial fib or flutter bc it blocks AV conduction (allowing heart to not beat sooo fast)
🗑
|
||||
| Explain how the DIRECT THERAPEUTIC levels of Digoxin work on the heart | show 🗑
|
||||
| Digoxin in a DIRECT way blocks the NA+/K+ ATPase pump which then acts on the Na+/Ca++ pump, incr Ca++ and releasing actin and myosin to contract==INCR CONTRACTILITY | show 🗑
|
||||
| show | AT THERAPEUTIC DOSES, T/ MAIN DIRECT EFFECT OF DIGOXIN IS TO INCR CONTRACTILITY
🗑
|
||||
| Explain how toxic Digoxin levels directly affect the heart: they reduce the resting potential esp in ventricular cells; after a while, ventricles get “itchy” to contract and you’ll see PVCs (premature ventricular contractions), | show 🗑
|
||||
| Explain how INDIRECT EFFECTS OF Digoxin on the heart | show 🗑
|
||||
| show | If you slow the heart and pump out more bld to tissues, then that reduces the 911/sympathetic activity
🗑
|
||||
| show | bioavailability of 70%; there are some who metabolize drugs in their gut, they get a larger dose; in elderly, give smaller dose of digoxin
🗑
|
||||
| What are SE/ADR of Digoxin? | show 🗑
|
||||
| show | pt is hungry, nauseated, seeing halos around lights
🗑
|
||||
| show | call physician and make sure if should continue dose
🗑
|
||||
| XS digoxin = pt death from ventricular fibrillation | show 🗑
|
||||
| What are different Digoxin interactions? | show 🗑
|
||||
| *hypokalemia sensitizes the heart to digitalis w/o changing the bld level | show 🗑
|
||||
| show | ACEI decr pre and afterload, so it tends to improve cardiac function; they also stop the remodeling of the heart (*start low and incr as needed; drug may take a couple weeks to show max effect)
🗑
|
||||
| Aldosterone causes what of the heart? What blocks that? | show 🗑
|
||||
| *Carvedilol (Coreg) ws 1st Beta-blocker approved for tx of mild/moderate HF of ischemic or cardiomyopathic origin in /c digitalis, diuretics, & ACEIs to reduce dz progression | show 🗑
|
Review the information in the table. When you are ready to quiz yourself you can hide individual columns or the entire table. Then you can click on the empty cells to reveal the answer. Try to recall what will be displayed before clicking the empty cell.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Created by:
Fukanwa
Popular Nursing sets