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Perini)
Note: Bring calculator
ACE inhibitors (Prils)
Onset 15 minutes
SE: Atrioventricular (AV) block,
Bronchospasm, nightmares, hypoglycemia in
diabetes
Inderal (propranolol) (specifically): Insomnia
Expected results: decreased HR, decreased B/P, Reduction of workload
of the heart
Measuring effectiveness: Reduction in angina, reduction of symptoms
associated with ADLs
Decrease CO, Decreases Renin Secretions
Digoxin
Amiodarone causes anorexia, pts. C/O funny taste Can cause serious cardiac
arrythmias
o Megase may be ordered to increase appetite, however causes prolonged
QT Interval
Marinal (Marijuana derivative) INCREASES appetite, but does not hurt the heart
Heparin:
What drug does the nurse keep on hand to reverse the
effects of
heparin
A) Antithrombin (Thrombate III)
B) Desirudin (Iprivask)
C) Protamine sulfate
Ask about peptic ulcers
Note: Heparin does not enter breast milk
arrhythmias
Troponin T & Troponin I only present in cardiac tissue, therefore, troponin is the
preferred test for a suspected heart attack because it is more specific for
heart injury than other tests (which may be elevated in the blood with skeletal
muscle injury) and remain elevated for a longer period of time.
Troponin is attached to the protein tropomyosin and lies within the groove between
actin filaments in muscle tissue. In a relaxed muscle, tropomyosin blocks the
attachment site for the myosin crossbridge, thus preventing contraction. When the
muscle cell is stimulated to contract by an action potential, calcium channels open
in the sarcoplasmic membrane and release calcium into the sarcoplasm. Some of
this calcium attaches to troponin, which causes it to change shape, exposing
binding sites for myosin (active sites) on the actin filaments. Myosins binding to
actin causes crossbridge formation, and contraction of the muscle begins.
In other words, the electrolyte, Calcium, inactivates troponin and allows actin
and myosin to form a bridge enabling the muscle fibers to contract.
Note: Troponin is found in both skeletal muscle and cardiac muscle, but the specific
versions of troponin differ between types of muscle. The main difference is that the
TnC subunit of troponin in skeletal muscle has four calcium ion-binding sites,
whereas in cardiac muscle there are only three. Views on the actual amount of
calcium that binds to troponin vary from expert to expert and source to source
Troponin is detectable within hours (average, 4 to 6 hours), peaks at 10 to 24 hours,
and can be detected for up to 10 to 14 days.
<100pg/ml = Normal
Brain Natriuretic Peptide
(Cardiac)
Increases in CHF
Related to reduction in Na= ions, the bodys attempt to control fluid
overload in the lungs
Misnomer, highest level does not exist in the brain, but in cardiac
ventricular muscle
These peptides oppose the renin-angiotensin system.
BNP are secreted when there is a stretch in the atrial or ventricular
muscles
Corresponds to left ventricular pressure
If BNP level is elevated, the SOB is caused by CHF
If BNP is normal, SOB is pulmonary
BNP can be elevated with acute MI, and prolonged systemic HTN
Definitions
chronotropic or chronotropy- Change the heart
rate/contractions. Firing of sinoatrial node.
Review Nitroglycerine and adverse effects.
Systemic vasculature
o Vasodilation - (venous dilation > arterial dilation)
o decreased venous pressure
o decreased arterial pressure (small effect)
Cardiac-reduced preload and afterload (decreased wall stress)
o decreased oxygen demand
Coronary-prevents/reverses vasospasm
o vasodilation (primarily epicardial vessels)
o improves sub-endocardial perfusion
o increased oxygen delivery
Nitrodilators are drugs that mimic the actions of endogenous Nitric
Oxide by releasing NO or forming NO within tissues. These drugs act directly
on the vascular smooth muscle to cause relaxation and therefore serve as
endothelial-independent vasodilators.
Therapeutic Indications: The primary pharmacologic action of
nitrodilators, arterial and venous dilation, make these compounds useful in
the treatment of hypertension, heart failure, angina and myocardial
infarction. Another beneficial action of nitrodilators is their ability to inhibit
platelet aggregation.
Hypertension: Nitrodilators are not used to treat chronic primary or
secondary hypertension; however, sodium nitroprusside and nitroglycerine
are used to lower blood pressure in acute hypertensive emergencies that
may result from a p
heochromocytoma, renal artery stenosis, aortic dissection, etc.
Nitrodilators may also be used during surgery to control arterial pressure
within desired limits.
Heart failure: Nitrodilators are used in acute heart failure and in severe
chronic heart failure. Arterial dilation reduces afterload on the failing
ventricle and leads to an increase in stroke volume and ejection fraction.
Furthermore, the venous dilation reduces venous pressure, which helps to
reduce edema. Reducing both afterload and preload on the heart also helps
to improve the mechanical efficiency of dilated hearts and to reduce wall
stress and the oxygen demands placed on the failing heart.
Review questions/answers in PP
What common action do both cardiac glycosides and
phosphodiesterase inhibitors have in common related to therapeutic
action? They both increase calcium in the cell
The phosphodiasterase inhibitors block the enzyme phosodiasterase.
This blocking effect leads to an increase in myocardial cell cyclic
adenosine monophosphate (cAMP), which increases Ca+ levels in the
cells.
Digoxin also increases intracellular calcium and allows more Ca+ to
enter myocardial cells during contraction.
True or False: The use of a loop diuretic is the first drug used in the
Step Care Management program to treat hypertension.
False: A somewhat controversial study, the ALLHAT study, reported
in 2002 that patients taking the less expensive, less toxic diuretics
did better and had better blood pressure control than patients using
other antihypertensive agents. Replications of this study have
supported its findings and the use of a thiazide diuretic is currently
considered the first drug used in the Step Care Management of
Hypertension.
The mechanism of action of an ACE inhibitor is the blocking of ACE
from converting angiotensin I to angiotensin II. What does this
cause? Decrease in aldosterone production
What is the leading cause of Heart Failure? CAD is the leading cause of HF,
accounting for approximately 95% of the cases diagnosed. CAD results in
an insufficient supply of blood to meet the oxygen demands of the
myocardium. Consequently, the muscles become hypoxic and can no
longer function efficiently. When CAD evolves into a myocardial infarction,
muscle cells die or are damaged, leading to an inefficient pumping effort.
The nurse is caring for a patient whose physician has just ordered
Cyclomen PO 800 mg daily in 2 divided doses. What disease process
would the physician be ordering the Cyclomen for? Endometriosis
The nurse is caring for a 27-year-old African American woman who was
just prescribed an ACE inhibitor for management of her hypertension.
What should be advised related to contraception?
Use barrier contraceptives to prevent pregnancy while taking these drugs.
The safety for the use of these drugs during pregnancy has not been
established. ACE inhibitors, ARBs, and renin inhibitors should not be used
during pregnancy, and women of child-bearing age should be advised to use
barrier contraceptives to prevent pregnancy while taking these drugs.