ruh roh
What does inotrope indicate? Chronotrope?
Inotrope is your hearts ability to SQUEEZE!
Chronotrope is your HEART RATE!
What are your two antiadrenergic adj. meds? What do they do?
Alpha 1- prazosin (mini press)
short acting, treatment of PTSD nightmares, <BP, treats HTN, HF, Raynaud’s
Alpha 2- clonidine (catapres)
>BP, used for hypotension, ADHD med
Which drug is the most common for fixing dysrhythmia issues?
Amiodarone! It eatssssss
When do we use synchronized cardio version?
In unstable SVT; delivers shock at certain part of cardiac cycle ON the heartbeat
What is most important when administering digoxin to a HF patient?
Check apical pulse for 1 full min prior to administration (hold <60)
Monitor electrolytes (specially potassium DUH.)
Monitor for toxicity
Draw serum digi levels to ensure therapeutic dose
Name your 5 inotropic drugs.
1) milrenone
2) norepi (levophed)
3) Furosemide/toresemide
4) nitroglyceride (acute exasperation)
5) Entresto (valsartan/sacubitril)
Side effects of your adj. meds?
Alpha 1 blockers have a “first pass’ effect (OH, palpitation, dizziness, take at bedtime for your first dose, reflex tachy, edema, blurred vision, urinary frequency, impotence)
Alpha 2 blockers have CNS depression, rebound hypertension, bradycardia, N/V, constipation, dry mouth
What is a downside/contraindication of Amiodarone?
Can’t take for a long time bc it can be toxic to lungs and thyroid
What is your neprilysin inhibitor and when do we give it?
Sacubitril; want to give this during cardio genic shock
Natriuretic peptides HELP the heart. During shock, this is released when the body senses a stretch in the heart. <Na+ which decreased blood volume. This is GOOD! We want the natriuretic effect. Helps patient get rid of extra fluid.
Neprilysin is what breais down the peptides, so we want to inhibit the breakdown in order for the heart to help itself.
If a patient is ill while on digoxin therapy, what do we suspect and do?
Suspect toxicity, hold meds and contact HCP
What medication is both indicated and contraindicated for HF?
Milrenone.
Milrinone when your patient is out of the hospital is indicated because it helps with decreased demand on the heart.
Milrinone when your patient is in the hospital is contraindicated because their tachycardia is keeping them alive because they are fighting for their life. Slowing their heart rate down would cause more problems.
What classifies something as hypertensive crisis?
Target organ damage, BP >180/120
In what order is anticoagulant meds preferred to be given?
1. Apixaban (eliquis)
2. Rivaroxaban (xarelto)
3. Warfarin; cheap, short term solution, NEED weekly INRs, no heavy activity
What drug is your Digoxin considered?
Positive inotrope; cardiac glycoside
Angiotensin Receptor-Neprilysin Inhibitor that blocks RAAS effects + sustains natriuretic peptide activity
Sacubitril/Valsartan (Entresto)
If a patient is having acute angina from their CAD, what is the nurse most likely to reach for?
Nitroglycerin, vasodilator
A patient is given isosorbide for their chronic angina. What medication can be given concurrently for optimal results?
Beta blocker (metoprolol)
Metoprolol has a neg. Chronotropic effect and will decrease the demand on the heart and O2 demand
Isosorbide > the supply, BB < the demand = happy heart and patient
Antidote to warfarin? What if its an emergency?
VIT K!
Emergency: Prothrombin complex concentrate
Antidote for digoxin?
Digibind, digoxin immune fab
What is a risk for Sacubitril/Valsartan (Entresto)?
Risk for angioedema, especially in African Americans
Your patient is prescribed nitroglycerin, but complains of continual chest pain still. What will the nurse most likely reach for next?
Isosorbide, vasodilator
Last’s a little longer in the bloodstream, not as susceptible to first past effect like nitroglycerin is
A patient is having ACUTE heart failure, what is the nurse reaching for an admitted patient?
Milrinone (GIVE ALONE!)
Milrinone is like the Amiodarone of HF… it eatsssss!
What are the steps for pulseless vtach?
1) CPR
2) Epi
3) defib
A patient is experiencing confusion, discoloration in vision, GI upset and lethargy. What could the HF patient be experiencing?
Digoxin toxicity (index is 0.8-2)
What line of drug is digoxin?
SECOND line drug; indicated for use in LEFT ventricular dysfunction