■ NUR 210 — UNIT 6 BABY STUDY GUIDE ■
Cardiac Glycosides | Antianginals | Antidysrhythmics | Anticoagulants | Antiplatelets | Thrombolytics | Statins |
Vasodilators
■ HOW TO USE THIS GUIDE
■ Yellow boxes = MEMORY TRICKS — say them out loud!
■ Red boxes = DANGER alerts — things that can hurt patients!
■ Blue boxes = PATIENT TEACHING — what to tell the patient!
■ Green boxes = GALEN lab values — use ONLY these on your exam!
■ = most tested — do NOT skip!
■ This guide covers EVERY Unit 6 drug from your teacher's med list!
❤■ HEART & BLOOD OVERVIEW — Understand This First!
■ MEMORY TRICK:
"The heart is like a PUMP. Blood is the WATER. Clots are BLOCKAGES in the pipes!"
When the pump beats WRONG rhythm → DYSRHYTHMIA drugs fix it When the pump beats TOO HARD/WEAK → DIGOXIN and
NITRATES help When arteries get BLOCKED by plaque → STATINS lower cholesterol to prevent blockage When CLOTS form in
blood → ANTICOAGULANTS and ANTIPLATELETS prevent them When CLOTS are ALREADY THERE → THROMBOLYTICS (clot
busters) DISSOLVE them ■ CARDIAC OUTPUT = Heart Rate × Stroke Volume SA node = the heart's natural pacemaker (starts at
100 bpm — PNS slows it to ~70) Ischemia = not enough O2 → cells become irritated → fire abnormally → ARRHYTHMIA
❤■ 3 TYPES OF ANGINA — Know the Difference!
1. STABLE (Classic) Angina: Chest pain with PREDICTABLE exertion or stress → rest relieves it
Think: "Stable = I know when it is coming — when I walk upstairs it always happens"
2. UNSTABLE (Pre-infarction) Angina: Chest pain at REST or with MINIMAL exertion → UNPREDICTABLE
Think: "Unstable = dangerous — could be an MI soon!"
3. VARIANT (Prinzmetal/Vasospastic) Angina: Chest pain at REST caused by CORONARY ARTERY SPASM
Think: "Variant = Vasospasm — artery squeezes shut while resting"
■ TREATMENT: Nitrates + Beta blockers + Calcium Channel Blockers
■ UNSTABLE ANGINA = call 911 if chest pain NOT relieved after 3 SL nitroglycerin doses 5 min apart!
■ CARDIAC GLYCOSIDE — DIGOXIN (Lanoxin)
■ GALEN: Digoxin therapeutic level 0.5–2 ng/mL | Toxic: > 2 ng/mL | HIGH ALERT MEDICATION
■ MEMORY TRICK:
"DIGOXIN = DIG IN and squeeze harder — but be VERY CAREFUL, the window is TINY!"
Digoxin has a NARROW THERAPEUTIC INDEX — tiny difference between helpful dose and toxic dose Think of it like a car
speedometer: normal = 0.5–2, anything above 2 = SPEEDING toward danger ■ THREE TOXICITY SIGNS (the TRIAD):
BRADYCARDIA + NAUSEA/VOMITING + YELLOW-GREEN VISION ■ LOW POTASSIUM (hypokalemia) + DIGOXIN = MORE
TOXICITY RISK (they are connected!) ■ ANTIDOTE = DIGIBIND (Digoxin Immune Fab) ■ HOLD if HR < 60 — take APICAL pulse
for 1 FULL MINUTE before EVERY dose
, ■ USES: ■ CONTRAINDICATIONS:
• HEART FAILURE — increases contractility (positive inotrope) • VENTRICULAR DYSRHYTHMIAS
→ ↑ cardiac output • BRADYCARDIA (already slow — digoxin slows it more)
• ATRIAL FIBRILLATION — slows HR through AV node • HYPOKALEMIA (low K+ makes digoxin more toxic)
(negative chronotrope) • RENAL DISEASE (drug excreted renally — accumulates!)
• HEART BLOCK
■■ HOW IT WORKS:
• Inhibits sodium-potassium ATPase pump → ↑ intracellular ■ DRUG INTERACTIONS:
calcium → stronger contractions • DIURETICS → cause hypokalemia → ↑ digoxin toxicity
• Positive INOTROPIC: ↑ force of contraction • ANTACIDS → DECREASE digoxin absorption
• Negative CHRONOTROPIC: ↓ heart rate (slows through AV • Cortisone → Na+ retention, K+ release → hypokalemia → ↑
node) toxicity
• Negative DROMOTROPIC: ↓ speed of conduction through
■ NURSING INTERVENTIONS:
heart cells
• ■ APICAL PULSE for 1 FULL MINUTE before every dose —
■■ SIDE EFFECTS / ADVERSE REACTIONS: HOLD if < 60 bpm
• Dizziness, weakness, headache, fatigue • Monitor serum digoxin level (0.5–2 ng/mL — Galen)
• ■ TOXICITY TRIAD: Bradycardia + N/V/Anorexia + • ■ Monitor POTASSIUM levels (3.5–5.0 mEq/L Galen) —
YELLOW-GREEN VISUAL HALOS hypokalemia = toxicity risk
• Premature ventricular contractions, cardiac dysrhythmias • Monitor for edema, lung sounds, S&S; of HF
• ■ HYPOKALEMIA increases toxicity risk! • Monitor renal function (BUN/Creatinine)
• HIGH ALERT MEDICATION — double check all doses
• Antidote = DIGIBIND (Digoxin Immune Fab)
■ PATIENT TEACHING — DIGOXIN (Page 506 from Teacher's Action Plan)
✔ Take digoxin at the SAME TIME every day — consistency is critical
✔ Check your PULSE for 1 full minute before each dose — do NOT take if below 60 bpm (call provider)
✔ Report immediately: nausea, vomiting, loss of appetite, seeing YELLOW-GREEN HALOS around lights, dizziness
✔ ■ If taking a DIURETIC (water pill): take potassium supplement as prescribed — low K+ makes digoxin dangerous
✔ Do NOT take antacids at the same time as digoxin — they reduce absorption (separate by 2 hours)
✔ Keep ALL follow-up appointments — regular blood levels must be checked
✔ Do NOT suddenly stop taking digoxin without talking to your provider
■ NITRATES — NITROGLYCERIN (Many Forms!)
■ MEMORY TRICK:
"NITROGLYCERIN = VASODILATOR. It OPENS the blood vessels. But it DROPS the
blood pressure!"
Think of nitroglycerin like a TRAFFIC JAM CLEARER for blood vessels: → Relaxes smooth muscle in vessel walls → vessels widen
(vasodilation) → More blood flows to the heart muscle → relieves angina pain → Decreases preload AND afterload → heart works
less hard ■ BIGGEST SIDE EFFECT: HYPOTENSION (BP drops — patient gets dizzy!) ■ MOST COMMON SIDE EFFECT:
HEADACHE (from vasodilation in head vessels) ■ DEADLY COMBINATION: Nitroglycerin + ED drugs (Viagra/Cialis/Levitra) =
FATAL HYPOTENSION — NEVER TOGETHER! ■ SL tablet: works in 1–3 minutes | lasts ~30 minutes
Cardiac Glycosides | Antianginals | Antidysrhythmics | Anticoagulants | Antiplatelets | Thrombolytics | Statins |
Vasodilators
■ HOW TO USE THIS GUIDE
■ Yellow boxes = MEMORY TRICKS — say them out loud!
■ Red boxes = DANGER alerts — things that can hurt patients!
■ Blue boxes = PATIENT TEACHING — what to tell the patient!
■ Green boxes = GALEN lab values — use ONLY these on your exam!
■ = most tested — do NOT skip!
■ This guide covers EVERY Unit 6 drug from your teacher's med list!
❤■ HEART & BLOOD OVERVIEW — Understand This First!
■ MEMORY TRICK:
"The heart is like a PUMP. Blood is the WATER. Clots are BLOCKAGES in the pipes!"
When the pump beats WRONG rhythm → DYSRHYTHMIA drugs fix it When the pump beats TOO HARD/WEAK → DIGOXIN and
NITRATES help When arteries get BLOCKED by plaque → STATINS lower cholesterol to prevent blockage When CLOTS form in
blood → ANTICOAGULANTS and ANTIPLATELETS prevent them When CLOTS are ALREADY THERE → THROMBOLYTICS (clot
busters) DISSOLVE them ■ CARDIAC OUTPUT = Heart Rate × Stroke Volume SA node = the heart's natural pacemaker (starts at
100 bpm — PNS slows it to ~70) Ischemia = not enough O2 → cells become irritated → fire abnormally → ARRHYTHMIA
❤■ 3 TYPES OF ANGINA — Know the Difference!
1. STABLE (Classic) Angina: Chest pain with PREDICTABLE exertion or stress → rest relieves it
Think: "Stable = I know when it is coming — when I walk upstairs it always happens"
2. UNSTABLE (Pre-infarction) Angina: Chest pain at REST or with MINIMAL exertion → UNPREDICTABLE
Think: "Unstable = dangerous — could be an MI soon!"
3. VARIANT (Prinzmetal/Vasospastic) Angina: Chest pain at REST caused by CORONARY ARTERY SPASM
Think: "Variant = Vasospasm — artery squeezes shut while resting"
■ TREATMENT: Nitrates + Beta blockers + Calcium Channel Blockers
■ UNSTABLE ANGINA = call 911 if chest pain NOT relieved after 3 SL nitroglycerin doses 5 min apart!
■ CARDIAC GLYCOSIDE — DIGOXIN (Lanoxin)
■ GALEN: Digoxin therapeutic level 0.5–2 ng/mL | Toxic: > 2 ng/mL | HIGH ALERT MEDICATION
■ MEMORY TRICK:
"DIGOXIN = DIG IN and squeeze harder — but be VERY CAREFUL, the window is TINY!"
Digoxin has a NARROW THERAPEUTIC INDEX — tiny difference between helpful dose and toxic dose Think of it like a car
speedometer: normal = 0.5–2, anything above 2 = SPEEDING toward danger ■ THREE TOXICITY SIGNS (the TRIAD):
BRADYCARDIA + NAUSEA/VOMITING + YELLOW-GREEN VISION ■ LOW POTASSIUM (hypokalemia) + DIGOXIN = MORE
TOXICITY RISK (they are connected!) ■ ANTIDOTE = DIGIBIND (Digoxin Immune Fab) ■ HOLD if HR < 60 — take APICAL pulse
for 1 FULL MINUTE before EVERY dose
, ■ USES: ■ CONTRAINDICATIONS:
• HEART FAILURE — increases contractility (positive inotrope) • VENTRICULAR DYSRHYTHMIAS
→ ↑ cardiac output • BRADYCARDIA (already slow — digoxin slows it more)
• ATRIAL FIBRILLATION — slows HR through AV node • HYPOKALEMIA (low K+ makes digoxin more toxic)
(negative chronotrope) • RENAL DISEASE (drug excreted renally — accumulates!)
• HEART BLOCK
■■ HOW IT WORKS:
• Inhibits sodium-potassium ATPase pump → ↑ intracellular ■ DRUG INTERACTIONS:
calcium → stronger contractions • DIURETICS → cause hypokalemia → ↑ digoxin toxicity
• Positive INOTROPIC: ↑ force of contraction • ANTACIDS → DECREASE digoxin absorption
• Negative CHRONOTROPIC: ↓ heart rate (slows through AV • Cortisone → Na+ retention, K+ release → hypokalemia → ↑
node) toxicity
• Negative DROMOTROPIC: ↓ speed of conduction through
■ NURSING INTERVENTIONS:
heart cells
• ■ APICAL PULSE for 1 FULL MINUTE before every dose —
■■ SIDE EFFECTS / ADVERSE REACTIONS: HOLD if < 60 bpm
• Dizziness, weakness, headache, fatigue • Monitor serum digoxin level (0.5–2 ng/mL — Galen)
• ■ TOXICITY TRIAD: Bradycardia + N/V/Anorexia + • ■ Monitor POTASSIUM levels (3.5–5.0 mEq/L Galen) —
YELLOW-GREEN VISUAL HALOS hypokalemia = toxicity risk
• Premature ventricular contractions, cardiac dysrhythmias • Monitor for edema, lung sounds, S&S; of HF
• ■ HYPOKALEMIA increases toxicity risk! • Monitor renal function (BUN/Creatinine)
• HIGH ALERT MEDICATION — double check all doses
• Antidote = DIGIBIND (Digoxin Immune Fab)
■ PATIENT TEACHING — DIGOXIN (Page 506 from Teacher's Action Plan)
✔ Take digoxin at the SAME TIME every day — consistency is critical
✔ Check your PULSE for 1 full minute before each dose — do NOT take if below 60 bpm (call provider)
✔ Report immediately: nausea, vomiting, loss of appetite, seeing YELLOW-GREEN HALOS around lights, dizziness
✔ ■ If taking a DIURETIC (water pill): take potassium supplement as prescribed — low K+ makes digoxin dangerous
✔ Do NOT take antacids at the same time as digoxin — they reduce absorption (separate by 2 hours)
✔ Keep ALL follow-up appointments — regular blood levels must be checked
✔ Do NOT suddenly stop taking digoxin without talking to your provider
■ NITRATES — NITROGLYCERIN (Many Forms!)
■ MEMORY TRICK:
"NITROGLYCERIN = VASODILATOR. It OPENS the blood vessels. But it DROPS the
blood pressure!"
Think of nitroglycerin like a TRAFFIC JAM CLEARER for blood vessels: → Relaxes smooth muscle in vessel walls → vessels widen
(vasodilation) → More blood flows to the heart muscle → relieves angina pain → Decreases preload AND afterload → heart works
less hard ■ BIGGEST SIDE EFFECT: HYPOTENSION (BP drops — patient gets dizzy!) ■ MOST COMMON SIDE EFFECT:
HEADACHE (from vasodilation in head vessels) ■ DEADLY COMBINATION: Nitroglycerin + ED drugs (Viagra/Cialis/Levitra) =
FATAL HYPOTENSION — NEVER TOGETHER! ■ SL tablet: works in 1–3 minutes | lasts ~30 minutes
