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Angina, HF, Antiarrhythmics Flashcards

1
Q

Nitrates prototypes

A

Isosorbide mononitrate

Nitroglycerin

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2
Q

Nitrate Therapeutic Actions

A

Relaxes blood vessels and drops BP

Acts directly on smooth muscle to cause relaxation, depress muscle tone, and relax and dilate veins, arteries, and capillaries.

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3
Q

Nitrates indications

A

Angina pectoris attacks

Treat and prevent attacks of angina pectoris

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4
Q

Nitrates phamaco

A

Rapid absorption
Hepatic metabolism
Urine excretion
Cross placenta and milk

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5
Q

Nitrate contraindications

A

HYPOTENSION
Allergy
Severe anemia
Head trauma/ cerebral hemorrhage

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6
Q

Nitrates Cautions

A

Hepatic + renal disease
Pregnancy + lactation
Hypotension, hypovolemia, and conditions that limit CO(cardiac output)

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7
Q

Nitrates AE

A

CNS EFFECTS (HEADACHE, DIZZINESS) FP
GI (N/V)
CV (hypotension) FP
Skin (rash, sweating)

All related to vasodilation and decrease in blood flow

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8
Q

Nitrates D-D Interactions

A

NO ED MEDS
No Sildenafil, cadilofil, or vardenafil (Phosphodiesterase type 5 inhibitors)

Ergot derivatives (fungi)
Heparin
Other drugs that can lower BP

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9
Q

How to give nitro

A

GET VITALS ESPESIALLY BP, FALL PRECAUTION

Wear gloves for paste
Have a sip of water for under the tongue admin
For oral: 1 tab q5mins 3 times
For patches: rotate sites, assess the skin, and no touchy patchy

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10
Q

Cardiac Glycosides prototype

A

Digoxin

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11
Q

Cardiac glycosides Therapeutic actions

A

Lets more Ca into the heart cells during depolarization. This causes:

SLOWED HR/ DECREASED CONDUCTION VELOCITY
Increased force of myocardial contraction
Increased CO and renal perfusion

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12
Q

Cardiac Glycosides indications

A

Treats HF, A flutter, Afib, and paroxysmal Atach

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13
Q

Cardiac Glycosides Pharmaco

A

Rapid onset and absorption
Widely distributed
Urine excretion, unchanged

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14
Q

Cardiac Glycosides Contraindications

A

RENAL INSUFFICIENCY (Check kidney function)
ELECTROLYTE ABNORMALITIES (Watch for hypokalemia)

Allergy
Vtach or Vfib
Heart block or sick sinus syndrome
Idiopathic hypertrophic subaortic stenosis
Acute MI

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15
Q

Cardiac Glycosides Nurse Considerations

A

DO NOT GIVE IF:

Apical pulse is less than 60 BPM

Potassium levels are low

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16
Q

Nitrates Nurse Considerations

A

BP and Pulse are priority assessments before administration, all other VS need to be taken too

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17
Q

Cardiac Glycosides Cautions

A

Pregancy and lactation

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18
Q

Cardiac Glycosides AE

A

DIGOXIN TOXICITY (anorexia, N/V, malaise, depression, irregular heart rhythms, atrial arrhythmias, and Vtach)
Digoxin immune Fac used to reverse/ treat, review lab work before telling provider

Most common: headache, weakness, drowsiness, vision changes
GI upset and anorexia
Arrhythmias

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19
Q

Cardiac Glycosides DD interactions

A

Verapamil, amiodarone, quinidine, quinine, erythromycin, tetracycline, cyclosporine
K-depleting diuretics
Thyroid hormons, metoclopramide, penicillamine, cholestyramine, charcoal, colestipol, antacids, bleomycin, cyclophosphamide, methotrxate
Ginseng, licorice, or hawthorn

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20
Q

Phosphodiesterase inhibitors prototype

A

Milrinone (generic)

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21
Q

Phosphodiesterase inhibitors Therapeutic actions

A

Blocks phosphodiesterase –> increased cAMP –> increased Ca level in heart cells –> stronger contractions and prolonged effects of sympathetic stimulation

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22
Q

Phosphodiesterase inhibitors indications

A

Short term treatment of HF that doesn’t respond to digoxin or diuretics

only for severe situations

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23
Q

Phosphodiesterase inhibitors Pharmaco

A

IV only
Widely distributed
Hepatic metabolism
Urine excretion

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24
Q

Phosphodiesterase inhibitors contraindications

A

ACUTE MI
allergy
Severe aortic or pulmonic disease
Fluid volume deficit
V arrhythmias

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25
Phosphodiesterase inhibitors Cautions
Pregnancy and lactation
26
Phosphodiesterase inhibitors AE
Most common: arrhythmias, hypotension, chest pain GI (N/V) Thrombocytopenia Hypersensitivity Burning at IV site
27
Phosphodiesterase inhibitors Nursing assessment
Hx and physical Known allergies, acute aortic or pulmonic valve disease, acute MI or fluid volume deficit, and V arrhythmias Pregnancy and lactation Cardiac status and heart sounds
28
Phosphodiesterase inhibitors DD interactions
FUROSEMIDE
29
Hyperpolarized-Activated Cyclic Nucleotide-Gated Channel Blockers prototype
Ivabradine (Corlanor)
30
Hyperpolarized-Activated Cyclic Nucleotide-Gated Channel Blockers Therapeutic Action
Blocks HCNs which slows the sinus node in the repolarization phase of the action potential, which leads to REDUCTION IN HR
31
Hyperpolarized-Activated Cyclic Nucleotide-Gated Channel Blockers Indications
Made to reduce the risk of hospitalization for worsening HF
32
Hyperpolarized-Activated Cyclic Nucleotide-Gated Channel Blockers Pharmaco
Rapid absorption through GI Hepatic and intestines metabolism Feces and bile excretion
33
Hyperpolarized-Activated Cyclic Nucleotide-Gated Channel Blockers Contraindication
Know allergy Active, decompensated HF Hypotension or HR less than 60 Sick sinus syndrome of AV block/ dependency on pacemaker Severe hepatic impairment
34
Hyperpolarized-Activated Cyclic Nucleotide-Gated Channel Blockers Cautions
Afib or moderate heart block pregnancy and lactation
35
Hyperpolarized-Activated Cyclic Nucleotide-Gated Channel Blockers AE
Most common: Bradycardia, hypertension, afib, luminous phenomena
36
Hyperpolarized-Activated Cyclic Nucleotide-Gated Channel Blockers DD interactions
Strong CYP3A4 inhibitors or inducers Other negative chronotropic drugs
37
Angiotensin receptor neprilysin inhibitor prototype
Entresto Valsartan + sacubitril
38
Angiotensin receptor neprilysin inhibitor Therapeutic actions
Blocks breakdown of natriuretic peptides and stops RAAS effects, leads to decreased cardiac workload, lowered vascular volume, lower BP, improve HF symptoms
39
Angiotensin receptor neprilysin inhibitor Indications
Reduces risk of CV death and hospitalization in adults with chronic HF Treats symptomatic HF with systemic left ventricular systolic dysfunction in peds patients over 1 year
40
Angiotensin receptor neprilysin inhibitor Pharmaco
Oral highly bound to plasma proteins urine and feces excretion
41
Angiotensin receptor neprilysin inhibitor contraindications
Allergy HX of angioedema related to exposure to ACEI or ARBs Concurrent use with an ACEI or aliskiren Pregnancy or lactation
42
Angiotensin receptor neprilysin inhibitor AE
Most common: Hypotension, hyperkalemia, cough, dizziness, renal impairment
43
Angiotensin receptor neprilysin inhibitor DD Interations
ACEI/ Alskiren K sparing diuretics Lithium Other nephrotoxic meds
44
Class Ia Antiarrhythmics Meds
Disopyramide Quinidine Procainamide
45
Class Ib Antiarrhythmics Meds
Lidocaine Mexeletine Tocainide
46
Class Ic Antiarrhythmics Meds
Moricizine Flecainide Propefanone
47
Class II Antiarrhythmics Meds (beta blockers)
Propanolol Atenolol Metorprolol
48
Class III Antiarrhythmics Meds (SAD)
Sotalol Amiodarone Dofelitide
49
Class IV Antiarrhythmics Meds
Diltiazem Verapamil
50
Class I Antiarrhythmics Therapeutic actions
Stablize cell membrane by binding to sodium channels, changing duration of action potential Really monitor cardiac rate and rhythm
51
Class I Antiarrhythmics Indications
TREATS POTENTIALLY LIFE THREATENING VFIB OR VTACH Preferable in conditions such as tachycardia
52
Class I Antiarrhythmics Pharmaco
Wide distribution from injection/ Rapid absorption through GI Extensive hepatic metabolism Urine excretion Cross placenta and human milk
53
Class I Antiarrhythmics Contraindications
Allergy Bradycardia or heart block HF, hypotension or shock Electrolyte disturbances
54
Class I Antiarrhythmics Cautions
Renal and hepatic dysfunction Pregnancy and lactation
55
Class I Antiarrhythmics AE
CNS (dizziness, safety precautions/ fall risk) GI (N/V) CV (hypotension)/ Resp depression Risk of new and more dangerous arrhythmias
56
Class I Antiarrhythmics DD interactions
Other drugs that cause arrhythmias Quinidine and digoxin Class Ia antiarrhythmics and cimetidine Warfarin
57
Class I Antiarrhythmics DF Interations
GRAPEFRUIT JUICE (especially in quinidine) Foods that alkalinize the urine (citrus juice, veggies, antacids, milk products)
58
Class II Antiarrhythmics Therapeutic Actions
Blocks beta-receptor sites in the heart and the kidneys, antagonist Results in decreased HR, cardiac excitability, CO, renin, and slows conduction through AV node
59
Class II Antiarrhythmics indications
Treats rapid AF, A flutter, paroxysmal SVTs, hypertension angina, PVCs, Vtach
60
Class II Antiarrhythmics Pharmaco
GI absorption Hepatic metabolism Urine excretion
61
Class II Antiarrhythmics Contraindications
Sinus bradycardia and AV block Cardiogenic shock or Resp depression Adenosine: 2nd or 3rd degree AV block, sinus node disease, known hypersensitivity to adenosine
62
Class II Antiarrhythmics Cautions
Diabetes and thyroid dysfunction ASTHMA OR COPD Pregnancy and lactation Renal and hepatic dysfunction
63
Class II Antiarrhythmics AE
CNS (CVA) CV/resp effects (Bracy, heart blocks, pulmonary edema) GI (flatulence, N/V, diarrhea, abd pain) Loss of libido, decreased exercise tolerance, alterations in blood sugar levels
64
Class II Antiarrhythmics DD interactions
Verapamil or Diltiazem (class IV) Antidiabetic meds
65
Class III Antiarrhythmics Therapeutic actions
Blocks potassium channels
66
Class III Antiarrhythmics Indications
Treats life threatening V arrhythmias Maintains sinus rhythm in pts with symptomatic Afib or A flutter
67
Class III Antiarrhythmics Pharmaco
Good oral absorption Widely distributed Hepatic metabolism Kidney excretion
68
Class III Antiarrhythmics Contraindications
NO SUCH THING WHEN USED FOR LIFE THREATENING ARRHYTHMIAS Ibutilide and defetilide (AV block) Dronedarone
69
Class III Antiarrhythmics Cautions
Shock, hypotension, or resp depression Prolonged QTc interval Renal or hepatic disease Amiodarone
70
Class III Antiarrhythmics AE
Common: N/V, weakness, dizziness, hypotension Brady or AV block that could progress to HF Blue/gray discoloration of skin
71
Class III Antiarrhythmics DD interactions
Digoxin or quinidine Antihistamines, phenothiazines, tricyclical antidepressants
72
Class IV Antiarrhythmics Therapuetic actions
Block movement of Ca ions across the cell membrane in cardiac and smooth muscle cells
73
Class IV Antiarrhythmics Indications
Treats angina and rapid supraventricular dysrhythmias
74
Class IV Antiarrhythmics Pharmaco
Good oral absorption Highly protein bound hepatic metabolism Urine excretion Cross placenta and milk
75
Class IV Antiarrhythmics Contraindication
Know CCB allergy Sick sinus syndrome or Heart block Severe HF or hypotension
76
Class IV Antiarrhythmics Cautions
Pregnancy and lactation Idiopathic hypertrophic subaortic stenosis Impaired renal or liver function
77
Class IV Antiarrhythmics AE
CNS (dizziness, headache, lightheadedness) GI (N) Hypotension, HF, shock, arrhythmias, AV block, edema
78
Class IV Antiarrhythmics DD interactions
Verapamil reacts with beta blockers, digoxin, carbamazepine, prazosin, quinidine Diltiazem reacts with cyclosporine, other antihypertensive/ negative chronotropic meds, and other negative inotropic meds
79
V Fib meds!
Amiodarone or Lidocain
80
AFib meds!
If no HF: Diltiazem (don't give this if EF is less than 40%) If HF: Metoprolol

Pharma 2 (9 decks)

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