Cardiac Pharmacology Part 2 - Nursing

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Karteikarten am Cardiac Pharmacology Part 2 - Nursing, erstellt von Eiei Uyhp am 04/06/2015.
Eiei Uyhp
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Eiei Uyhp
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CARDIAC GLYCOSIDES example and action Example: Digoxin Action: Inhibits active transport of Na+ and K+ across myocardial cell membrane, and thus the sodium pump. Increases contractility, decreases HR
CARDIAC GLYCOSIDES indication and adverse reactions Indication: Heart failure, atrial fibrillation, atrial flutter, atrial tachycardia, cardiac arrhythmias Adverse reactions: Bradycardia, ectopic beats, heart block, headache, confusion, nightmares, disturbed colour vision
CARDIAC GLYCOSIDES nursing care considerations • Monitor serum levels • Pulse rate must be <60bpm before administration • Caution in PT with renal impairment • Monitor vital signs • PT education – med, condition • Serum urea and electrolyte monitoring
NITRATES example and action Example: Glyceryl trinitrate [GTN] Action: Relax smooth muscle →vasodilation. Decrease myocardial oxygen demand by reducing preload and after load. Decrease BP
NiTRATES indication and adverse reactions Indication: Prophylaxis and treatment of angina pectoris Adverse reactions: Reflex tachycardia, hypotension, flushing, headache, dizziness, dry mouth, abdominal pain, vomiting, restlessness, palpitations
NITRATES nursing care considerations • Monitor vital signs • PT education • Take as early in the attack as possible, sitting down for 10-20 minutes after • Care with handling GTN as it can be absorbed through skin • SR – prevention of angina attacks • Fast acting – treats acute angina attacks
ANTIARRYTHMIC AGENTS CLASS I example and action Example: Lignocaine Action: Block sodium channels during phase 0 of action potential, slow repolarisation and have local anaesthetic effects
ANTIARRYTHMIC AGENTS CLASS II example and action Example: Atenolol Action: Beta adrenergic receptor blockers – prevent sympathetic stimulation
ANTIARRYTHMIC AGENTS CLASS II| example and action Example: Amiodarone Action: Block potassium channels and prolong phase 3 of an action potential
ANTIARRYTHMIC AGENTS CLASS IV example and action Example: Verapamil Action: Calcium channel blockers shorten the action potential, disrupting ineffective rhythms and rates
HEPARIN action Augments the natural inhibitor of coagulation, antithrombin III, preventing the conversion of prothrombin to thrombin. Prevents further clotting but has no effect on existing clot. Administered parenterally
HEPARIN indication and adverse reactions Indication: venous thromboembolism, prophylaxis for clot formation, extracorporeal circulation Adverse reactions: haemorrhage, local irritation, mild pain, haematoma, elevated liver enzymes, osteoporosis after prolonged high dose therapy, early/internal bleeding
HEPARIN nursing care considerations • Monitor APTT (activated partial thromboplastin time) • Administering and maintaining the correct dosage within the therapeutic range by regular monitoring of blood concentration • Low dose heparin does not require monitoring • Antidote: protamine sulfate
WARFARIN action Interferes with hepatic syntheses of prothrombin and factors VII, IX and X Prevents the extension of established clot/formation of new clots. Administered orally
WARFARIN indication and adverse reactions Indication: prevention and management of DVT or pulmonary embolism Adverse reactions: bleeding, alopecia, fever, hypersensitivity
WARFARIN nursing care considerations • Monitor INR (international normalized ratio) used to regulate dosage • Antidote: phytomenadione
ANTI-PLATELET AGENTS example and action Example: Aspirin Action: Decrease platelet aggregation by effecting platelet adhesiveness and reducing thrombus formation
ANTI-PLATELET AGENTS indication and adverse reactions Indication: Prophylaxis following cardiac valve replacement, increased risk of thromboembolic stroke, acute MI Adverse reactions: Bleeding (major and minor), thrombocytopenia, hypotension, bradycardia, chest pains, dyspnea
ANTI-PLATELET AGENTS nursing care considerations • Platelet count monitored before starting therapy, 2-4 hours after bolus dose and at 24 hours or just before discharge • Caution and contraindications: presence of any known bleeding disorders, recent surgery, closed head injuries, pregnancy, lactation • Solution should be administered alone • Any haematoma measured and frequently checked for enlargement • Monitor vitals and neurological status closely • Educate PT about reporting signs of bleeding, avoid risky activities
THROMBOLYTICS example and action Example: Alteplase Action: Activates plasminogen to form the proteolytic enzyme plasmin, which breaks down fibrin and therefore dissolves the clot
THROMBOLYTICS indication and adverse reactions Indication: MI, pulmonary embolism Adverse reaction: Minor/major bleeding, haemorrhage (IV site), arrhythmias, tachy/bradycardia, hypotension, anaphylactic reactions
THROMBOLYTICS nursing care considerations • Treatment should be started ASAP after onset of symptoms • Should only be used in hospital setting by experienced doctors • Recent puncture sites should be carefully monitored for bleeding • Avoid injections • Monitor vitals
HMG-CoA REDUCTASE INHIBITORS (STATINS) example and action Example: Atorvastatin Action: Inhibit HMG-CoA reductase, lowering cholesterol synthesis, increasing liver LDL receptors (low density lipoprotein) → lowering LDL levels
HMG-CoA REDUCTASE INHIBITORS (STATINS) indication and adverse reactions Indication: Hyperlipidaemia, prevention of CVD Adverse reactions: GI disturbances, headache, myalgia, insomnia, rash, constipation, alopecia, myopathy
HMG-CoA REDUCTASE INHIBITORS (STATINS) nursing care considerations • Monitor serum lipid levels regularly throughout therapy • Liver function test should be performed before therapy at 6 and 12 weeks, then twice yearly • Caution: PT with history of liver disease, impaired liver function, or excessive alcohol consumption • Educate PT: report muscle pain, cramps, tenderness/weakness, malaise, dark urine/fever, avoid large amounts of alcohol
CHOLESTEROL ABSORPTION INHIBITOR example and action Example: Ezetimibe Action: Inhibits absorption of cholesterol in the small intestine, decreasing the amount of intestinal cholesterol reaching the liver, → reduced liver cholesterol stores and increased clearance in blood
CHOLESTEROL ABSORPTION INHIBITOR indication and adverse reactions Indication: Hypercholesterolaemia Adverse reactions: Myalgia (with statins), elevated liver enzymes and CPK
CHOLESTEROL ABSORPTION INHIBITOR nursing care considerations • Any secondary causes of hypercholesterolaemia should be identified and treated before starting therapy • Liver function tests should be performed at start and regularly throughout therapy if given with statins • Not recommended for PTs with impaired liver function • Contraindicated with statins in those with active liver disease • Educate PT on reporting muscle pain, cramps, tenderness, weakness, malaise, fever → CPK concentration should be measured
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