NUR 210 PHARMACOLOGY UNIT 6 CHAPTERS 40, 43 AND 44

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Questions and Answers

Digoxin exerts which combination of effects on the heart muscle?

  • Negative inotropic, negative chronotropic, and positive dromotropic.
  • Negative inotropic, positive chronotropic, and negative dromotropic.
  • Positive inotropic, negative chronotropic, and negative dromotropic. (correct)
  • Positive chronotropic, negative inotropic, and positive dromotropic.

A patient with atrial fibrillation is prescribed digoxin. What is the primary goal of digoxin therapy in this scenario?

  • Convert the atrial fibrillation to a normal sinus rhythm.
  • Increase blood pressure to improve cardiac output.
  • Slow the heart rate by decreasing electrical impulses through the AV node. (correct)
  • Prevent thromboemboli formation.

Which assessment finding would indicate that a patient taking digoxin may be experiencing digitalis toxicity?

  • Increased urine output.
  • Decreased heart rate. (correct)
  • Improved breathing.
  • Increased appetite.

A patient with heart failure is prescribed digoxin. What therapeutic effects are expected from this medication?

<p>Increased cardiac output and decreased fluid retention. (A)</p> Signup and view all the answers

Why is digoxin considered a secondary drug in the treatment of heart failure?

<p>It does not prolong life, but improves the quality of life. (D)</p> Signup and view all the answers

A patient is prescribed digoxin tablets. Approximately what percentage of the oral dose is expected to be absorbed by the body?

<p>70% to 80% (D)</p> Signup and view all the answers

Considering digoxin's half-life, what potential issue should nurses monitor for in patients taking this medication?

<p>Drug accumulation leading to toxicity. (D)</p> Signup and view all the answers

Besides digoxin what other medications are commonly prescribed concurrently to manage A-Fib and prevent systemic complications?

<p>Calcium Channel Blockers and Warfarin (D)</p> Signup and view all the answers

Which lipoprotein primarily functions to transport fatty acids and cholesterol to the liver and is mainly composed of triglycerides?

<p>Chylomicrons (C)</p> Signup and view all the answers

If a patient's blood test reveals an elevated level of LDL, which of the following health risks is most associated with this condition?

<p>Increased risk of atherosclerotic plaques (A)</p> Signup and view all the answers

A patient taking both beta blockers and calcium channel blockers reports experiencing frequent dizziness. What is the MOST appropriate initial action?

<p>Advise the patient to notify their healthcare provider, as dizziness may indicate hypotension. (B)</p> Signup and view all the answers

A patient is looking to improve their cholesterol levels through dietary changes. Which of the following actions would be the MOST appropriate first step?

<p>Reducing saturated fats and cholesterol to less than 30% of caloric intake and 300mg/day, respectively. (A)</p> Signup and view all the answers

A patient's lipid panel shows the following values: Cholesterol 210 mg/dL, Triglycerides 160 mg/dL, LDL 130 mg/dL, HDL 40 mg/dL. Based on the provided information, how would you categorize this patient's cholesterol level?

<p>Moderate Risk (C)</p> Signup and view all the answers

Why should nitroglycerin ointment or patches not be applied to areas of the chest where a defibrillator-cardioverter paddle might be placed?

<p>Explosion and skin burns may result during defibrillation. (D)</p> Signup and view all the answers

Which of the following statements accurately describes the function and composition of high-density lipoprotein (HDL)?

<p>HDL removes cholesterol from the bloodstream and delivers it to the liver for excretion in bile. (D)</p> Signup and view all the answers

A patient is prescribed immediate-release nifedipine in a hospital setting. For what specific condition is this medication MOST likely being used?

<p>As needed for acute increases in blood pressure. (B)</p> Signup and view all the answers

Why is ventricular fibrillation considered a life-threatening dysrhythmia?

<p>It results in ineffective filling of the ventricles and diminished or absent cardiac output. (A)</p> Signup and view all the answers

A patient is advised to reduce their total fat intake to 30% or less of their caloric intake. If the patient consumes 2000 calories per day, what is the maximum amount of calories that should come from fat?

<p>600 calories (C)</p> Signup and view all the answers

A patient asks why the doctor is focusing on lowering their LDL cholesterol. What is the best explanation you can give them?

<p>Elevated LDL is associated with a higher risk of developing plaques and heart disease. (B)</p> Signup and view all the answers

What immediate intervention is MOST crucial for a patient experiencing ventricular tachycardia?

<p>Cardiopulmonary resuscitation (CPR). (C)</p> Signup and view all the answers

Which lipoprotein is characterized by carrying mostly triglycerides and less cholesterol?

<p>VLDL (B)</p> Signup and view all the answers

Which of the following factors can contribute to the development of cardiac dysrhythmias?

<p>Electrolyte imbalance. (C)</p> Signup and view all the answers

What physiological event is represented by the QRS complex on an ECG?

<p>Ventricular depolarization. (B)</p> Signup and view all the answers

During cardiac cell depolarization, which electrolytes primarily enter the cell?

<p>Sodium and calcium. (C)</p> Signup and view all the answers

A patient experiencing chest pain is prescribed sublingual nitroglycerin. If the pain is not relieved after the first dose, what is the most appropriate next step, according to the provided information?

<p>Call 911 if the pain has not subsided or has worsened in 5 minutes. (A)</p> Signup and view all the answers

Why is it important to advise patients against ingesting alcohol while taking nitroglycerin?

<p>Alcohol can exacerbate the side effects of nitroglycerin, such as hypotension. (B)</p> Signup and view all the answers

A patient has been taking sustained-release nifedipine for several months. What specific risk is least associated with this form of nifedipine, compared to the immediate-release formulation?

<p>Sudden cardiac death. (A)</p> Signup and view all the answers

A patient who has been prescribed a calcium channel blocker and a beta blocker is advised not to discontinue these medications abruptly. What is the primary reason for this advice?

<p>To avoid potential withdrawal symptoms such as reflex tachycardia and pain. (A)</p> Signup and view all the answers

Which of the following vital sign changes would warrant particular caution before administering nitroglycerin?

<p>Marked hypotension. (C)</p> Signup and view all the answers

A patient taking antianginal medications reports experiencing persistent chest pain despite taking the medication as prescribed. What is the most appropriate action?

<p>Notify a healthcare provider about the unrelieved chest pain. (A)</p> Signup and view all the answers

How do diltiazem and nifedipine differ in their likelihood of causing hypotension as a side effect?

<p>Nifedipine is more likely to cause hypotension than diltiazem. (B)</p> Signup and view all the answers

What is the general duration of action for nifedipine and diltiazem, according to the provided text?

<p>6 to 8 hours (C)</p> Signup and view all the answers

A patient is prescribed a Class IB antiarrhythmic drug. Which electrophysiological effect is most likely to occur?

<p>Shortened repolarization and slowed conduction. (B)</p> Signup and view all the answers

Which class of antiarrhythmic drugs is characterized by prolonging repolarization and action potential duration in ventricular dysrhythmias?

<p>Class III (B)</p> Signup and view all the answers

A patient with supraventricular tachycardia is prescribed a calcium channel blocker. What is the primary mechanism by which this medication helps to control the arrhythmia?

<p>Blocking calcium influx and slowing conduction velocity. (B)</p> Signup and view all the answers

A patient is experiencing acute ventricular dysrhythmias. Which class of antiarrhythmic drugs is typically indicated for this condition?

<p>Class IB (B)</p> Signup and view all the answers

Which of the following is the primary electrophysiological effect of Class II antiarrhythmic drugs (beta blockers)?

<p>Reducing calcium entry and decreasing automaticity. (C)</p> Signup and view all the answers

A patient is prescribed disopyramide phosphate. For which specific condition is this medication most likely indicated?

<p>Life-threatening ventricular tachycardia. (B)</p> Signup and view all the answers

A patient with a history of atrial fibrillation and heart failure requires an antidysrhythmic drug. Which of the listed medications would be most appropriate, considering its effect on myocardial contractility?

<p>A beta blocker to reduce calcium entry. (B)</p> Signup and view all the answers

In a patient with paroxysmal supraventricular tachycardia (PSVT), which class of antiarrhythmic drugs is most effective for preventing recurrent episodes?

<p>Calcium channel blockers (Class IV). (C)</p> Signup and view all the answers

A patient with acute decompensated heart failure is prescribed milrinone lactate. Which assessment finding would warrant immediate notification of the healthcare provider?

<p>A drop in potassium levels along with complaints of chest pain. (B)</p> Signup and view all the answers

Which of the following best describes the mechanism of action of nesiritide in treating acute decompensated heart failure?

<p>Stimulating guanylate cyclase, leading to increased cGMP levels and vasodilation. (D)</p> Signup and view all the answers

A patient receiving digoxin-immune Fab (Digifab) for digitalis toxicity develops rapid atrial fibrillation. What is the most likely explanation for this occurrence?

<p>The binding of Digifab to digoxin is reducing vagal tone, resulting in an increased atrial rate and potential fibrillation. (C)</p> Signup and view all the answers

A patient with heart failure and reduced ejection fraction is started on vericiguat. Which of the following instructions is most important to emphasize for this patient?

<p>Monitor blood pressure regularly, especially when standing up. (D)</p> Signup and view all the answers

A patient with hypothyroidism is prescribed digoxin. How should the dosage be adjusted, and why?

<p>Decrease the dose; hypothyroidism decreases digoxin metabolism. (B)</p> Signup and view all the answers

A patient is being transitioned from intravenous milrinone to oral medications for long-term management of heart failure. What key consideration should guide the choice of oral agents?

<p>The oral medications should address the underlying cause of heart failure and provide complementary mechanisms of action. (B)</p> Signup and view all the answers

A patient is prescribed digoxin and vericiguat. What potential drug interaction should the healthcare provider monitor for?

<p>Increased risk of hypotension. (D)</p> Signup and view all the answers

A patient with heart failure is receiving digoxin. Which of the following electrolyte imbalances is most likely to increase the risk of digoxin toxicity?

<p>Hypokalemia (B)</p> Signup and view all the answers

Flashcards

Positive Inotropic Action

Increases myocardial contraction, stroke volume, and cardiac output.

Negative Chronotropic Action

Decreases heart rate.

Negative Dromotropic Action

Decreases conduction speed of heart cells within the AV node.

Digoxin's Overall Effect

Increases heart's contraction strength, improving circulation and kidney function.

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First-line IV drugs for Acute HF

Dopamine, dobutamine, milrinone. Used for acute heart failure.

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Verapamil Use in AFib

Atrial fibrillation rate control.

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Digoxin

An oral cardiac glycoside that increases the force of heart contractions.

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Digoxin Half-Life

30-40 hours, leading to possible accumulation and toxicity.

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Milrinone Lactate

Increases cardiac contractility, used for acute decompensated heart failure.

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Nesiritide

Used for acute decompensated heart failure, can cause orthostatic hypotension.

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Digoxin-immune Fab

Antidote for digitalis overdose and cardiac glycoside–induced dysrhythmias.

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Vericiguat

Used for heart failure with reduced ejection fraction (<45%).

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Thyroid Dysfunction

Can alter the metabolism of cardiac glycosides.

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Hypothyroidism and Digoxin

Dose should be decreased for patients with this condition.

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Hyperthyroidism and Digoxin

Dose may need to be increased for patients with this condition.

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Digitalis Toxicity

May result in first-degree, second-degree, or complete heart block.

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Antianginal Drugs

Drugs used to prevent angina (chest pain) by improving blood flow to the heart.

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Perfusion

The passage of blood flow through arteries and capillaries, delivering oxygen and nutrients to cells.

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Hypotension

A common side effect of calcium channel blockers, especially nifedipine.

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Reflex Tachycardia

A rapid heart rate that can occur upon sudden withdrawal from beta blockers.

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Nitroglycerin

A medication used to relieve chest pain (angina).

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Nitroglycerin and Alcohol

Do not ingest alcohol while taking nitroglycerin to avoid hypotension, weakness, and faintness.

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Discontinuing Beta Blockers and Calcium Blockers

Do not stop taking beta blockers and calcium channel blockers without the approval of your health provider.

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SL Nitroglycerin Administration

Place the tablet under the tongue, allowing it to dissolve and absorb quickly.

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Beta Blockers/Calcium Blockers & Dizziness

Notify your healthcare provider if dizziness or faintness occurs, as it may indicate hypotension.

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Nitroglycerin Patch & Defibrillation

Do not apply nitroglycerin ointment or patches near defibrillator paddle placement to prevent burns and explosions.

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Cardiac Dysrhythmia (Arrhythmia)

A deviation from the normal rate or pattern of the heartbeat, including rates that are too slow, too fast, or irregular.

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Life Threatening Dysrhythmias

Ineffective filling and pumping of the ventricles result in decreased or absent cardiac output.

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Ventricular Tachycardia Consequence

Ventricular fibrillation is likely to occur, followed by death.

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Cardiac Dysrhythmia Treatment

Any cardiac dysrhythmia requires this intervention.

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Hypoxia and Dysrhythmias

Lack of oxygen to body tissues; can cause cardiac dysrhythmias.

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QRS Complex

The QRS complex indicates ventricular depolarization.

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Class IA Antiarrhythmics

Slow conduction and prolong repolarization in cardiac tissue.

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Class IB Antiarrhythmics

Slow conduction and shorten repolarization.

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Class IC Antiarrhythmics

Prolong conduction with minimal effect on repolarization

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Class II Antiarrhythmics

Reduce calcium entry, decreasing velocity, automaticity and recovery time.

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Class III Antiarrhythmics

Prolong repolarization, extending the action potential duration.

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Class IV Antiarrhythmics

Block calcium influx, slowing conduction velocity and contractility.

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Sodium Channel Blockers

Decreases conduction velocity in cardiac tissue, increases myocardial recovery time, and suppresses automaticity.

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Disopyramide phosphate Use

For life-threatening dysrhythmias, such as ventricular tachycardia.

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HDL (High-Density Lipoprotein)

Transports cholesterol from the bloodstream to the liver for excretion.

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LDL (Low-Density Lipoprotein)

Contains 50% to 60% of cholesterol in the blood; contributes to plaque formation.

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VLDL (Very-Low-Density Lipoprotein)

Carries mostly triglycerides and less cholesterol.

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Chylomicrons

Large particles that transport fatty acids and cholesterol to the liver, composed mostly of triglycerides.

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Dietary Changes for Cholesterol Reduction

Reducing saturated fats and cholesterol in the diet.

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Total Fat Intake

Should be 30% or less of caloric intake for cholesterol management.

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Cholesterol Intake Limit

Should be 300 mg/day or less for cholesterol management.

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Endogenous Cholesterol

Internally derived cholesterol, often unaffected by diet alone.

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Study Notes

Cardiac Glycosides, Antianginals, and Antidysrhythmics Overview

  • This chapter discusses drugs to regulate heart contraction, relieve angina, and correct irregular heartbeats.
  • Cardiac glycosides, antianginals, and antidysrhythmics regulate heart contraction, rate, rhythm, and myocardial blood flow

Cardiac Glycosides

  • Differentially affect cardiac glycosides' actions.
  • Blockage of vessels can inhibit blood flow.
  • Digitalis use dates back to CE 1200 and remains relevant for treating heart failure.
  • Digitalis, derived from foxglove, can be poisonous if not purified properly.
  • Digitalis treats heart failure, also called cardiac failure, and previously congestive heart failure.
  • Heart failure occurs when the myocardium weakens and enlarges, impairing blood pumping.
  • Acute heart failure happens if compensatory mechanisms fail, and tissues are congested.
  • HF is commonly caused by hypertension, MI, CAD, or congenital defects
  • Left-sided HF impairs left ventricle contraction, causing lung tissue backup and shortness of breath.
  • Right-sided HF impairs right atrium blood pumping, backing blood into systemic tissues and causing edema. Atrial Fibrillation & Flutter
  • Digoxin treats cardiac dysrhythmias, like atrial fibrillation and flutter that causes rapid contractions.
  • The drug negatively impacts chronotropic and dromotropic function to slow heart rate and conduction.
  • When digoxin cannot convert atrial fibrillation (irregular heartbeat), the goal is to reduce rate by decreasing electrical impulses through the AV node.
  • Verapamil, a calcium channel blocker (CCB), may be prescribed when digoxin falls to convert Atrial Fibrillation.
  • Warfarin could be co-administered to avoid thromboemboli

Medication Toxicity & Nursing Interventions

  • Monitor adverse effects of drug accumulation
  • Monitor for signs and symptoms of digitalis toxicity including anorexia and nausea
  • Toxicity also indicated by bradycardia with pulse rate below 60 beats per minute
  • Serum digoxin levels are drawn in digitoxicity and the results are used to ascertain extent of such toxicity and whether to adjust the dosage.

Antianginal Drugs

  • These drugs aim to treat angina pectoris, chest pain that happens because inadequate blood flow to the heart
  • Angina pectoris results from either plaque occlusions or spasms of the coronary arteries.
  • The pain is frequently labeled as tightness, pressure, or severe referred pain sensation.
  • The three types of angina are classic(stable), unstable(pre-infarction), variant(Prinzmetal, vasospastic)
  • Nonpharmacologic measures to control angina include avoiding heavy meals, smoking, extreme weather changes, strenuous exercise, and emotional upset. Antianginal Drug Classes
  • The three drug classes are nitrates, beta blockers, and calcium channel blockers
  • Nitrates reduce venous tone, decreasing the workload of the heart and promoting vasodilation, while beta blockers and CCBs decrease the workload, and oxygen needs.
  • Immediate medical attention to patients with unstable angina.
  • Nitrates were the first agents used to relieve angina by causing generalized vascular and coronary vasodilation to increases blood flow

Nitroglycerin

  • If cardiac pain persists after the first dose of .4mg nitroglycerin after 5 minutes, then dial 911
  • Sublingual tablets are readily absorbed into the circulation and are available for topical and IV administration too Side Effects & Actions
  • Common side effects include headache, hypotension, dizziness, flushing, faintness
  • Vasodilation: decreases cardiac preload/afterload
  • Decreased oxygen demand

Beta Blockers

  • Beta-adrenergic blockers lower heart rate and blood pressure by blocking catecholamines actions.
  • These are often used for angina, dysrhythmia, and hypertension especially for classic(stable) angina
  • Beta Blockers must be weaned under advice of medical professional
  • Monitor for signs and symptoms that can occur, including bronchospasm

Calcium Channel Blockers (CCBs)

  • CCBs are useful for treating hypertension
  • CCBs work by relaxing coronary artery spasms and dilating peripheral arterioles, decreasing cardiac oxygen demand
  • Bradycardia is a potential issue with verapamil, while nifedipine could trigger hypotension because it is among the most potent vasodilators.

Antidysrhythmic Drugs

  • A cardiac dysrhythmia refers to any deviation from normal rate or rhythm of heartbeat.
  • Can be too slow, or too fast(tachycardia) but both are deviations
  • The ECG is used to identify the type of dysrhythmia with various indicators
  • Atrial dysrhythmias prevent proper filling of the proper chambers to function to greatest efficiency causing decrease in output by 33%
  • Ventricular dysrhythmias are life-threatening because ineffective chamber filling leads to decreased/absent cardiac output.
  • CPR necessary to mitigate these risks

Cardiac Action Potentials

  • Electrolyte transfer occurs through the cardiac muscle cell membrane.
  • Depolarization occurs and then repolarization which returns membrane potentials to resting state
  • Electrolytes and drugs used can have a tangible effect on the function

Types of Antidysrhythmic Drugs

  • The desired action of antidysrhythmic (antiarrhythmic) drugs is to restore the cardiac rhythm to normal.
  • Antidysrhythmics are grouped into four classes
  • Sodium Channel Blockers
  • Beta Blockers
  • Drugs that prolong repolarization
  • Calcium Channel Blockers
  • Lidocaine is still first point of call for Acute Ventricular Dysrhythmias and affects conduction rates.

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