Little bit of cardio

​Cardiac meds

By Rikki Zepponi

Multiple Choice

What is the priority Assessment: Before administering beta-blockers like metoprolol.

• Check BP and RR

• Check BP and HR

• Check HR and mental status

• Check BP and urine output

How Beta blockers work

Beta- adrenergic blockers work by competitively binding to beta adrenoceptors, blocking the effects of endogenous catecholamines (think epi and norepinephrine, they elevate blood pressure through vasoconstriction). This competitive antagonism prevents catecholamine-mediated stimulation of the heart and other tissues. They reduce HR, decrease myocardial contractility, slow atrioventricular conduction, and suppress renin releases from juxtaglomerular cells.

Collectively these effects reduce myocardial oxygen demand by decreasing cardiac workload. The heart rate slowing also increases diastolic time which improves coronary perfusion and myocardial oxygen supply.

Multiple Choice

A patient with a history of asthma should be monitored closely when prescribed a nonselective beta-blocker, as it may exacerbate respiratory issues. True or false

• True

• False

Epi and norepinephrine cause bronchodilation to enhance oxygen delivery. When using beta blockers once can worsen some breathing conditions.

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Beta Receptors

B1 selective agents are meds like metoprolol and atenolol, bisoptolol, and nebivolol.

Non selective (B1 and B2)- propranolol, carvedilol, timolol

Beta blockers have proven mortality benefits in heart failure with reduced EF and post-MI patients with reduced LVEF.

-Recent MI and LVEF <40%
-B-blockers reduce mortality and adverse remodeling.
-We often see carvedilol used

​Post MI

-3 beta blockers have demonstrated mortality reduction in HFrEF. bisoprolol, carvedilol, and sustained release metoprolol succinate.

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HFrEF

• Beta blockers use to be used for HTN but they are no longer first line. They are inferior for preventing mortality and stroke.

Multiple Choice

Patient education about beta blockers should include:

• Signs of low heart rate

• signs of low bp

• the importance of reporting symptoms of dizziness and fatigue

• all of the above

Multiple Select

The nurse is conducting a health history on a patient who is taking a beta blocker. Which assessment data presents contraindications or cautions to beta blocker therapy? Select all that apply

• History of asthma

• Second degree AV block

• Type 2 DM

• Gout

• Pregnancy

-Asthma- use with caution and pick a medication that is more selective.
-2nd degree AV block. Beta blockers can worsen conduction through the AV node and potentially precipitate complete HB.
-Use with caution in DM. A lot of DM2 patients will be on these medications because DM is hard on the heart and the patient may have had an MI or other condition needing a beta blocker. Issue is some b-blockers like metoprolol and atenolol cause a compensatory mechanism that increases peripheral vasoconstriction. This leads to increased insulin resistance and more atherogenic lipid profile (think tight tubes).

Multiple Choice

What is a frequent side effect of calcium channel blockers (e.g., amlodipine, diltiazem).

• Peripheral edema

• Rhabdo

• Heart failure

• palpitations

Multiple Choice

Mr. A is a 68 y/o male admitted to the tele unit for heart failure with fluid overload. Admitting EKG showed SR. Mr. A was started on albumin once, lasix 80mg BID. He continued his beta blocker, insulin and GLP-1. He has been at the hospital for three days. Today on his rhythm strip you T wave inversion, ST depression, and a U wave. Mr. A says overall he feels fine, maybe a little more fatigued, definitely constipated, and a little weak. What is your next step.

• Call Dr. and notify them of the change.

• Look at labs and then call Dr. to notify them of the change.

• Continue to monitor. these are all expected findings. You can talk to the Dr. When they round.

Multiple Choice

What is the most likely cause of Mr. A's change on EKG?

• Heart attack

• Hyperkalemia from lasix

• Hypokalemia from lasix

• Exhaustion from being in the hospital

Something to think about. Mr. A is also taking insulin. What is something we give to patients when their potassium is high? Granted we give it IV but insulin still pulls potassium into the cell.