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Cardiac Drugs and Nursing Considerations
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1
Question
What is the primary action of cardiac glycosides (e.g., digoxin)?
Answer
Cardiac glycosides slow cardiac conduction through the AV node to lower heart rate and improve cardiac contractility, thereby increasing cardiac output.
2
Question
What are two primary clinical indications for digoxin?
Answer
Heart failure (to improve cardiac output) and atrial fibrillation (to control ventricular rate).
3
Question
Name two major adverse reactions associated with digoxin.
Answer
Bradycardia and dysrhythmias (arrhythmias) are major adverse reactions.
4
Question
List four common side effects or signs of digoxin toxicity.
Answer
Dizziness/weakness, headaches, visual changes (yellow/green halos, blurred vision), anorexia, nausea/vomiting. Visual disturbances are classic.
5
Question
What monitoring is important for a patient starting digoxin?
Answer
Monitor apical HR before administration (withhold if HR <60), ECG for arrhythmias, digoxin serum levels (therapeutic ~0.5–2 ng/mL depending on source), and potassium levels because hypo/hyperkalemia affects toxicity.
6
Question
What is the mechanism of action of nitrates (e.g., nitroglycerin)?
Answer
Nitrates promote vasodilation by relaxing smooth muscle in blood vessels, increasing blood flow to myocardium and reducing cardiac workload and oxygen demand.
7
Question
What are primary indications for nitroglycerin?
Answer
Unstable angina and acute myocardial infarction (for chest pain relief and improving myocardial oxygen balance).
8
Question
Name two important adverse reactions or hemodynamic effects of nitrates.
Answer
Orthostatic hypotension and reflex tachycardia (tachycardia).
9
Question
List common side effects patients may experience with nitroglycerin.
Answer
Dizziness, weakness, headaches, blurred vision, flushing, and syncope (from hypotension).
10
Question
What are important nursing considerations when administering nitrates?
Answer
Monitor blood pressure and heart rate before and after administration, educate about orthostatic precautions, assess for relief of chest pain, and be cautious if using with phosphodiesterase inhibitors (e.g., sildenafil).
11
Question
What is the primary action of calcium channel blockers such as diltiazem?
Answer
Calcium channel blockers dilate and relax coronary arteries, slow cardiac conduction, and decrease cardiac contractility — lowering heart rate and dilating vessels.
12
Question
For what cardiac condition is diltiazem commonly used?
Answer
Variant (Prinzmetal) or vasospastic angina; it’s also used for rate control in some tachyarrhythmias and hypertension.
13
Question
What are significant adverse reactions of calcium channel blockers like diltiazem?
Answer
Hypotension and bradycardia are notable adverse reactions.
14
Question
Name common side effects of calcium channel blockers.
Answer
Dizziness, peripheral edema, flushing, erectile dysfunction, and fatigue.
15
Question
What monitoring should nurses perform for patients on calcium channel blockers?
Answer
Monitor blood pressure and heart rate before and after administration and observe ECG rhythm with initial dosing; assess for signs of heart block in patients with low BP or HR.
16
Question
What is the mechanism of action for beta blockers (e.g., acebutolol)?
Answer
Beta blockers block beta-1 adrenergic receptors in cardiac tissue, decreasing sympathetic outflow to the heart — which lowers heart rate and reduces myocardial contractility.
17
Question
List three therapeutic uses of beta blockers.
Answer
Prevention of premature ventricular contractions (PVCs), management of hypertension, and treatment of some arrhythmias and ischemic heart disease.
18
Question
What are common adverse reactions of beta blockers?
Answer
Bradycardia, hypotension, palpitations (on initiation or withdrawal), chest pain, and potentially bronchospasm in susceptible patients.
19
Question
What are typical side effects patients might report with beta blockers?
Answer
Fatigue, dizziness, syncope, decreased libido, night terrors, and possible erectile dysfunction.
20
Question
What precautions should nurses take when administering beta blockers?
Answer
Monitor vital signs (BP and HR) and ECG before and during therapy, assess for signs of heart failure, and use cautiously in patients with asthma or diabetes due to bronchospasm and masking of hypoglycemia.
21
Question
What is the action of potassium channel blocker amiodarone?
Answer
Amiodarone delays impulses by blocking potassium channels and prolongs the recovery time between cardiac cycles, converting or sustaining lethal ventricular rhythms.
22
Question
For what types of arrhythmias is amiodarone indicated?
Answer
Life-threatening ventricular tachycardia and ventricular fibrillation, and it’s used for various refractory supraventricular and ventricular arrhythmias.
23
Question
List key adverse reactions associated with amiodarone.
Answer
Involuntary movements, bradycardia, hypotension, skin discoloration, corneal deposits, hepatotoxicity, and pulmonary toxicity (e.g., pulmonary fibrosis).
24
Question
What are important side effects patients should know about when taking amiodarone?
Answer
Fatigue, confusion, dizziness, nausea/vomiting/anorexia, photosensitivity, and visual disturbances.
25
Question
What monitoring is essential for patients on amiodarone?
Answer
Monitor vital signs and ECG rhythm, liver and renal function tests, pulmonary status (for signs of fibrosis), and ophthalmologic exams as indicated.
26
Question
What is the mechanism and therapeutic purpose of antiplatelet drugs like aspirin and clopidogrel?
Answer
Antiplatelet drugs block platelet aggregation in the bloodstream to prevent thrombosis in arteries; they are used prophylactically to reduce risk of myocardial infarction and stroke.
27
Question
List major adverse effects of aspirin and clopidogrel.
Answer
Aspirin: bleeding, Reye’s syndrome in children, GI irritation/peptic ulcer risk. Clopidogrel: bleeding, potential hypotension, elevated liver enzymes, peptic ulcer risk, and rare severe bleeding.
28
Question
What nursing monitoring and education are important for patients on antiplatelet therapy?
Answer
Monitor for signs of bleeding, check CBC and liver enzymes as indicated, assess for GI upset and peptic ulcer disease risk, and advise patients to report unusual bleeding, bruising, or black stools.
29
Question
What is the action of adrenergic agonists such as epinephrine?
Answer
Adrenergic agonists directly stimulate alpha and beta receptors of the sympathetic nervous system, increasing cardiac stimulation, bronchodilation, and blocking histamine release.
30
Question
Name two life-saving indications for epinephrine.
Answer
Anaphylaxis and cardiac arrest (to support circulation and airway).