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Classifica- Ca+ Channel

tion ACE Inhibitors Beta Blockers K+ Channel Blockers Cardiotonics


Blockers

conversion of slows action potential decreasses conduction


MOA
A-I to A-II; vasodilator decreases HR decreases conduction (fibrillation) of electrical impulses

*atenolol *amiodarone
*captopril
*carvedilol
*verapamil *adenosine
*enalapril *diltiazem effects of digoxin
Drug *lisinopril *metoprolol *amlodipine *propafenone *digoxin
Names *ramipril *nifedipine *procainamide (0.8 - 2 ng/mL)
*sotalol
*trandolapril *Alpha's dine & sin *felodipine *ibutilide *digitoxin
*fosinapril *clonidine, *prazosin *nicardipine *sotalol (14 - 26 ng/mL)

HTN, CAD, SVT,


HTN, AV block, SVT, HTN, a.fib/flutter, SVT, A.fib,
A.fib/flutter,
Cardiac A.fib/flutter, bradycardia, impaired
SVT, junctional A.fibw/RVR CHF/HF
dysthythmia, CONTRAINDICATED
Treat-
ment
junctional peripherial circulation,
chronic stable
SVT, heart block, V.tach/fib,
dysrhythmia, chronic stable angina pregnancy
stable angina
CAUTION - in asthma pt's -
bronchospasms; & DM pts - can
angina VT/VF CAUTION
advanced HF &
mask s/s of hypoglycemia CAUTION - in HF renal insuffieiency

digoxin toxicity:
hypoT, dizziness, fatigue, AV block (prolonged PR HF, AV block, pulmonary
N/V, brady, P hypoT, KCL - IV or PO
headache, ARF, K+, interval), bradycardia, toxicity, painful breathing,
Side fatigue, bronchospasms, early s/s - N/V/D,
Effects
angioedema, skin rash, hypoT, pulmonary edema, cough, SOB, weakness in
hyperglycemia, head/dizz, brady/tachy, PVC's,
cough, loss of taste, CHF, headache, dizziness, arms/legs, trouble walking,
drowsiness, CHF, ED bi/trigeminy
N/V/C, GI irritation flushing, rash, fever,chills dizziness, lightheadedness
late s/s - visual changes

*assess BP, HR, skin, *ortho BP, LFT's, *I/O, s/s of CHF, *assess BP, AP, lung
weight (daily or weekly) pulm.edema/lungs, *assess BP, RR, apical &
facial edema, K+ radial pulses, renal & LFT sounds, JVD, weight,
serum, renal tests *hold if apical < 60 daily weight, pain level sputum, extremity
*hold HR>120 or <60
Nursing *hold SBP <100 *hold if SBP < 100 *BP & HR q3-4h *safety/safety/safety edema, renal & LFT's
Manage- *ASA/NSAIDs may *avoid EtOH, OTC's, *hold if apical < 60 *keep all aptmts-MD, labs, *teach pt's s/s of
ment reduce effectivness & hazardous tasks if *hold if SBP < 100 etc. & follow diet plan digoxin toxicity
*full effect on BP dizzy; rise slowly *may cause 1 HB *avoid EtOH, smoking, *no herbal drugs
*do not stop abruptly *take with meals OTC's, swallow whole,
may not be seen wax may be found in stool *K+ rich diet; monitor
*caution use with *pines are for BP; varapimil
for 3-6 wks African Americans & diltiazem for dysrhythmias* K+ levels
Classifica-
tion Direct Vasodilators Statin Drugs Antiplatelet Anticoagulation Anticholinergenic

relax arteriolar smooth decrease platelet antiparasympathetic;


inhibit synthesis of prolong the formation
MOA muscle, causing aggregation & inhibit transient
blood vessel dilation cholesterol in liver of blood clotting
thrombus formation phase of stimulation

*warfarin
*atorvastain
*hydrazaline
*ASA Antidote = Vitamin K
Drug
*nitroglycerin *lovastatin PT- 9.6-11.8seconds
(sublingual, patch, & paste) *clopidogrel INR- 2-3x norm (1.5-2.0) *atropine
Names
*isosorbide mononitrate *simvastatin *heparin, *enoxaprin
*sodium nitroprusside bisulfate
*fluvastatin Antidote = Protamine Sulfate
aPTT therapeutic - 60-80

MI or re-infarction, A.fib/flutter, MI,


CAD, stroke DVT, PE, stroke
HTN, chronic HDL
Cardiac
Treat- stable angina, HF
CONTRAINDICATED
pregnancy (3rd trimester), CONTRAINDICATED bradycardia,
ment
after MI CAD bleeding disorders or
thrombocytopenia
thrombocytopenia
CAUTION Mobitz II
CAUTION PUD, severe HTN,
PUD, hepatic/renal disease hemophelia

headache, dizziness, HR, BP, bruising,


NVCD, elevated liver hematuria, bruising, can't see, can't pee
palpitations/tachy, petechiae, black/tarry
Side enzymes, myopathy, epistaxis, confusion, GI can't spit, can't sh*t
Effects N/V, hypoT, flushing stools, bleeding in
rhabdomylosis, ulcers or upset, tachycardia, agitation,
*reactions lessen with urine/gums, vasculitis,
GI disturbances, rash hemorrhage delirium, NVC, ED
prolonged use/dose adjust hemorrhage

*take on an empty stomach *take with food/milk *assess for


*monitor LFT's prior to *avoid all IM injections
*if headache develops treat *advise patient of
w/ASA or acetaminpohen
& q6-12wks after
prolonged bleeding time;
*inspect & teach for tachycardia; may
start of therapy abnormal bleeding
*advise patient to take an
*use in adjunction with
notify HCP of unusual
*teach a diet consistent in lead to V.fib
Nursing additional dose prior to bleeding *monitor I/O; may
diet therapy; restrictions of vitamin K is essential
Manage- anticipated stress & have *may cause dizziness or
ment drug accessible at all times saturated fat & cholesterol *med ID bracelet, electric cause urinary
drowsiness
*review dietary habits, razor, soft toothbrush
*keep record of attacks
weight, & exercise patterns
*inform HCP before
*contact HCP prior to retention
*assess pregnancy status undergoing any procedures *give IV over
*CK - if muscle pain or taking any OTC or
*avoid EtOH or new drug therapy
weakness occurs herbal therapy 1 minute
*do not mix w/other drugs *NO ASA or NSAIDs
Dysrhythmia EKG Characteristics Causative Agents Treatments
bb, CCB, MI, ICP/IOP, O2, atropine, pacemaker,
Sinus
Bradycardia
< 60 bpm & regular hypothermia, drug dosage adjusted or
hypoglycemia, discontinued
exercise, fever, fear, anxiety,
pain, hypoT, hypovolemia, O2, bb, treat underlying cause,
Sinus
Tachycardia
101 - 200 bpm & regular anemia, hypoxia, antipyretics-fever, analgesics-
hypoglycemia, hyperthyroid, pain
stress, physical
MI, HF fatigue,
Premature
60 - 100 bpm & irregular; caffeine, EtOH, tobacco,
Atrial remove cause, bb,
P-wave may be hidden in the electrolyte balances,
Contraction
preceding T-wave hyperthyroid, hypoxia, COPD, observation
(PAC)
Supraventric CAD O2, remove cause, IV
150 - 220 bpm & regular; hypokalemia, digitalis toxicity,
ular adenosine, amiodarone, bb,
P-wave often hidden in the T- ischemia, CAD, cor pulmonale,
Tachycardia CCB,
wave rheumatic heart disease
(SVT) cardioversion, observation
A: 200 - 600 bpm; HTN, CAD, cardiomyopathy, O2, digoxin, bb, CCB, warfarin,
A.Flutter/ V: > or < 100 bmp digoxin, epinephrine, HF, EtOH cardioversion, ablation
A.Fib *a.flutter = F waves; a.fib = intoxication, caffeine, stress, A.fib w/RVR*amiodarone,
irregular* cardiac surgery propafenone
prolonged P-R interval; digoxin toxicity, bb, O2, check meds/labs, call HCP
1 AV Block If R is far from P = 1st CCB, *if new onset, continue to
monitor
MI, CAD
P-wave = longer, longer, O2, temp pacemaker, ERT, VS,
2 AV Block; digoxin toxicity, bb, atropine, check meds/labs,
longer, call HCP, permanent
Wenkenbach
DROP = Wenkenbach CAD pacemaker
digoxin toxicity, CAD, O2, temp pacemaker, ERT,
2 AV Block; If some QRS's don't get
anterior MI, rheumatic VS, meds/labs, call HCP,
Mobitz II through = Mobitz II *permanent pacemaker
heart disease
severe heart disease, CAD,
O2, ERT, VS, meds/labs, call
3 AV Block; If P's & Q's don't MI, myocarditis, CM, bb,
HCP, *permanent pacemaker
complete agree = 3rd CCB, scleroedema, ASAP
amyloidosis
caffeine, EtOH, nicotine,
PVC's occur at variable rates;
amniophylline, epinephrine, digoxin, O2, bb, amiodarone,
unifocal or multifocal, couplets,
PVC bi/tri/quadrigeminy;
isoproterenol, hypoxia, fever, procainamide,
emotional stress, exercise,
3+ sequential PVC's = VT MI, HF, CAD, MV
hyperkalemia, prolapse
drug toxicity, lidocaine
150 - 250 bpm; acidosis, CPR, defibrillate,
V.Tach/V.Fib QRS's are wide & distorted; CM, MI, CAD, MV prolapse,
not measurable in v.fib HF, epinephrine
Dx Tests Description & Purpose Nursing Considerations
EKG recording for 24-48 hours
encourage to stimulate conditions
correlating rhythm changes
Holter that produce symptoms; keep an
w/symptoms in diary; recorder is
Monitoring accurate diary of activities &
used to store, recall, print & analyze
symptoms; no bath or shower
info for rhythm disturbances
ultrasound of chest & heart;
measures assess for allergy to shellfish; supine
Echocardiogr EF% - IV contrast may be used to position on left side of equipment;
am enhance images; also records no contraindications to procedure
direction of unless contrast is being used
blood flow across valves
sused as substitute for exercise stress start IV infusion; monitor VS
test in people unable to exercise; before/during/after until baseline
Pharmacologi
dobutamine or dipyridamole infused achieved; aminophylline given to
c Echo
via IV & dose increased in 5 min prevent or reverse
intervals to detect abnormalaties side effects of dipyridamole
NPO 6 hours prior; IV sedation &
Transesophag probe w/ultrasound transducer is throat anesthetized; designated
eal swallowed & passes down esophagus; driver needed;
Echocardiogr contrast may be injected IV for bite block placed-suctioning as
am evaluating blood flow if atrial or needed;
(TEE) ventricular septa defect is suspected no eating/drinking until gag reflex
returns
exercise tolerance, ADL's, pt to wear comfortable clothes/shoes
rhythm disturbances, EKG & walk as quickly as possible; hold bb
Exercise & caffeine
Stress Test
changes; contraindications 24 hrs prior to procedure; no smoking
acute CV disease, recent MI (2 3 hrs prior; test is terminated for
weeks), angina chest discomfort
nuclear images are taken at rest & after
exercise; injection given at max HR on
explain to eat only a light meal
Exercise bicycle/treadmill & continue for 1 min to between scans; certain
Nuclear circulate; scanning done medications may need to be
Imaging 15-60min after exercise; resting scan 60- held for 1-2 days before the
90min
after initial infusion or 24 hours later scan

Pharmacologi dipyridamole or adenosine to hold all caffeine products


c Nuclear promote vasodilation when 12 hours prior to procedure;
Imaging unable to exercise hold bb & CCB 24 hours prior

IV injection of radioisotopes; establish IV line - pt will have to lie


measures blood flow to heart at rest still on back with arms extended for
Nuclear & while your heart is working harder 20 minutes;
Cardiology as a result of repeat scans are performed within a
exertion or medication; HCP few minutes to hours after the
suspects CAD injection
used to evaluate myocardium at risk
Single-photon for MI;
Emission small amounts of radioactive isotope establish IV line; ECG
Computed injected via IV; detects coronary
Tomography artery blood flow, intracardiac shunts, monitoring
(SPECT) motion of ventricles,
EF% & size of heart chambers
Dx Tests Description & Purpose Nursing Considerations
contrast injected to examine
withhold food/fluids 6-18 hours; give
structure & motion of heart &
Cardiac sedative; instruct patient to deep
coronary arteries;
Catheterizatio breath when dye is injected; assess
also provides information to
n circulation, peripherial pulses, color,
determine
& sensation q15min/1 hour after
need for angioplasty or stenting
small amount of blood removed, mixed
w/radioactive isotope & reinjected; establish IV line, EKG
Multigated
EKG's used for timing, images acquired
Acquisition during cardiac cycle; indicated for MI, monitoring;
Scan (MUGA) HF, valvular HD, procedure involves little risk
cardiotoxic drugs on the heart

Magnetic used for vascular occlusive


contraindicated w/allergies to
Resonance disease & AAA; same as MRI
contrast or implanted metal
Angiography but with use
(MRA) devices
of gadolinium as IV contrast
evaluates heart muscle,
procedure is quick & involves
Cardiac CT coronary artery circulation,
little to no risk; assess for
Scan pulmonary veins, thoracic aorta,
shellfish allergies
pericardium; IV contrast
invasive study to record cardiac discontinue antidysrhythmic
Electro- electrical conduction using catheters meds several days prior to
physiology via femoral & jugular veins into right study; NPO 6-8h, IV sedation if
Study (EPS) side of heart; dysrhythmia can be needed; frequent VS &
induced & terminated continuous EKG after procedure
injection of contrast into veins
check for iodine allergy; mild
Peripherial or arteries followed by serial x-
sedative; check extremity
Arteriography rays to detect atherosclerotic
& Venography plaques, occlusions, aneurysms, puncture, pulsation, warmth,
motion, swelling, bleeding;
or trauma
Dx Labs Description & Purpose Nursing Considerations
* earliest increase 4-6 hours, peak < 0.5 ng/mL - normal
hours 10-24 hrs
0.5 - 2.3 ng/mL - suspicious for MI
Troponin - I * duration of increase 4-7 days
* specificity 95%; sensitivity at peak
injury
98% > 2.3 ng/mL - positive for MI injury
* earlies increase 4-8 hrs; peak hours
24-36 hrs cardiac biomarker used to
Creatine
* duration of increase 36-48 hours
Kinase (CK) * specificity 57-88%; sensitivity at peak diagnose MI & necrosis
93-100%
* earliest increase 3-4 hours; peak hrs
explain the purpose of serial
15-24 hrs sampling
CK-MB * duration of increase 24-36 hours (e.g. 3x q6-8h); normal is 0.3
* specificity 93-100%; sensitivity at peak mcg/L
94-100%
in conjunctioncirculation
cleared from with serialrapidly
EKG's
99-100% sensitive for MI; &
serum concentration rise 30-60min after
most diagnostic if measured
Myoglobin MI
male: 5.2-12.9 umol/L; female: 3.7-10.4 within
umol/L first 12 hours of onset of chest
pain