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N317: Pharmacology > Anti-lipemic and Anti-anginal Medications > Flashcards

Anti-lipemic and Anti-anginal Medications Flashcards

1
Q

What is angina a “fancy” term for?

What is angina pectoris?
- why might it happen?

A

Angina = chest pain

Angina pectoris = brief ischemic moment (losing oxygen)
- block in the arteries
- spasm

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2
Q

In what instances are angina medications prescribed?

A

Generally prescribed for chronic, stable angina i.e., prophylactically

For example, someone who gets angina every time they eat a heavy meal or mow the lawn

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3
Q

Nitrates

  • Treats what types of angina?
  • How does it treat angina?
  • Longer-acting would treat what type of angina?
  • Shorter-acting would treat what type of angina?
  • Contraindications?
  • Tolerance in what instance? How is tolerance prevented?
A

Treats:
- Stable angina (chronic)
- Unstable angina (new onset)
- Vasospastic angina (spasm)

Treats angina by:
- Vasodilating coronary arteries i.e., getting more oxygen to the tissues
- Relaxing smooth muscles

Longer-acting/slow release = prevention of episodes; prophylactic

Fast-acting/fast release = treatment of episode

Contraindications:
- Allergy
- Severe anemia
- Hypotension
- Erectile dysfunction drugs (Sildenafil, tadalafil, vardenafil)

Tolerance:
- occurs in patients taking around the clock/long-acting forms
- prevented by having nitrate-free period

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4
Q

Nitrites

  • Treats what types of angina?
  • How does it treat angina?
  • Longer-acting would treat what type of angina?
  • Shorter-acting would treat what type of angina?
  • Contraindications?
A

Treats:
- Stable angina (chronic)
- Unstable angina (new onset)
- Vasospastic angina (spasm)

Treats angina by:
- Vasodilating coronary arteries i.e., getting more oxygen to the tissues
- Relaxing smooth muscles

Longer-acting/slow release = prevention of episodes; prophylactic

Fast-acting/fast release = treatment of episode

Contraindications:
- Allergy
- Severe anemia
- Hypotension
- Erectile dysfunction drugs (Sildenafil, tadalafil, vardenafil)

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5
Q

Isosorbide Dinitrate

A

Class = Nitrate

Treats angina by:
- vasodilating coronary arteries
- relaxing smooth muscles

Prescribed for:
- STEADIER chest pain prevention
- consistent chest pain

*Taken more on a daily basis

Contraindications:
- allergy
- erectile dysfunction medications

Tolerance:
- occurs in patients taking around the clock/long-acting forms
- prevented by having nitrate-free period

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6
Q

Nursing implications for nitrates and nitrites:
- General?
- SL? (6 main points)
- Topical/transdermal? (5 main points)
- IV?

A

*SL (sublingual):

  • Medication should be carried with the pt at all times, especially in the case of allergy-induced angina
  • Instruct patients to never chew or swallow (needs to be dissolved under the tongue)
  • Potency of medication is lost 3 months after the bottle is opened
  • Should take medication as SOON as you start feeling chest pain and sit or lie down (dizziness)
  • Instruct pt to wait 5 mins between doses if angina is not resolved; can take up to 3 SL tablets
  • If dosage is maxed out and angina is not resolved, go to emergency department

*Topical/transdermal:

  • patient’s should take “breaks” or have nitrate-free period to reduce tolerance
  • pt should be instructed to alternate sites and make sure old patch is removed
  • pt should have clean hands when applying and clean hands afterwards (to avoid contact with eyes, face, genitals)
  • pt should be careful with disposal, especially if they’re a caregiver of children
  • don’t rub directly on to the skin; rub paste on something first before applying to the skin

*IV:

  • if giving IV, there is likely something besides ischemic event going on
  • Need to perform frequent assessments to monitor medication effects and condition
  • Should only give medication if fluid is colorless
  • Sometimes requires special tubing/bags –> follow manufacturers instructions
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7
Q

What do Lipid medications target?
- What labs would you consider for this target?

A

Lipid medications are drugs which work to target high cholesterol; lower cholesterol

Labs:
- High-density lipoprotein (HDL; “good”)
- Low-density lipoprotein (LDL; “bad”)
- triglyceride levels

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8
Q

What is high cholesterol a risk factor for?
- Why?

A

Risk factor for:
- MI (myocardial infraction)/heart attack
- Ischemic events (lack of oxygen to tissue)

Why? –> arteries become blocked or narrowed so blood is unable to move easily throughout vessels

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9
Q

low-density lipoprotein (LDL)

A

“Bad cholesterol”

responsible for transporting cholesterol to organs and tissues; excess amounts result in the accumulation of fatty deposits on artery walls.

*We still need fat, just not high levels of deposits

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10
Q

High-density lipoprotein (HDL)

A

“Good cholesterol”

responsible for transporting cholesterol (LDL) out of the arteries, thereby protecting against fat accumulation, blockages, narrowing blood vessels

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11
Q

Atorvastatin (Lipitor)

  • Class?
  • Works where?
  • Decreases cholesterol by?
  • Side effects?
  • Nursing considerations?
  • Medication interactions?
A

Class = HMG-CoA Reductase inhibitors (liver enzyme involved in cholesterol synthesis)

Works in the:
- Liver

Decreases cholesterol by:
- Lowering LDL levels *very effective - up to 50% lowering
- increasing HDL levels
- reducing triglyceride levels (not main effect)

Side effects:
- GI
- Short-term elevated liver enzymes (indicate inflammation or damage to liver cells)
- Rhabdomylosis –> muscle breakdown –> looking for extremely dark urine (kidney processing muscle) and complains of new muscle pain (can lead to kidney failure)

Nursing considerations:
- Medication should be taken in the evening (most of cholesterol is synthesized at this time)

Medication interactions:
- Warfarin –> can make levels toxic
- E-mycin
- Grapefruit juice
- Azoles (anti-fungals)

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12
Q

Simvastatin (Zocor)

  • Class?
  • Works where?
  • Decreases cholesterol by?
  • Side effects?
  • Nursing considerations?
  • Medication interactions?
A

Class = HMG-CoA Reductase inhibitors (liver enzyme involved in cholesterol synthesis)

Works in the:
- Liver

Decreases cholesterol by:
- Lowering LDL levels *very effective - up to 50% lowering
- increasing HDL levels
- reducing triglyceride levels (not main effect)

Side effects:
- GI
- Short-term elevated liver enzymes (indicate inflammation or damage to liver cells)
- Rhabdomylosis –> muscle breakdown –> looking for extremely dark urine (kidney processing muscle) and complains of new muscle pain (can lead to kidney failure)

Nursing considerations:
- Medication should be taken in the evening (most of cholesterol is synthesized at this time)

Medication interactions:
- Warfarin –> can make levels toxic
- E-mycin
- Grapefruit juice
- Azoles (anti-fungals)

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13
Q

Pravastatin (Pravachol)

  • Class?
  • Works where?
  • Decreases cholesterol by?
  • Side effects?
  • Nursing considerations?
  • Medication interactions?
A

Class = HMG-CoA Reductase inhibitors (liver enzyme involved in cholesterol synthesis)

Works in the:
- Liver

Decreases cholesterol by:
- Lowering LDL levels *very effective - up to 50% lowering
- increasing HDL levels
- reducing triglyceride levels (not main effect)

Side effects:
- GI
- Short-term elevated liver enzymes (indicate inflammation or damage to liver cells)
- Rhabdomylosis –> muscle breakdown –> looking for extremely dark urine (kidney processing muscle) and complains of new muscle pain (can lead to kidney failure)

Nursing considerations:
- Medication should be taken in the evening (most of cholesterol is synthesized at this time)

Medication interactions:
- Warfarin –> can make levels toxic
- E-mycin
- Grapefruit juice
- Azoles (anti-fungals)

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14
Q

Rosuvastatin (Crestor)

  • Class?
  • Works where?
  • Decreases cholesterol by?
  • Side effects?
  • Nursing considerations?
  • Medication interactions?
A

Class = HMG-CoA Reductase inhibitors (liver enzyme involved in cholesterol synthesis)

Works in the:
- Liver

Decreases cholesterol by:
- Lowering LDL levels *very effective - up to 50% lowering
- increasing HDL levels
- reducing triglyceride levels (not main effect)

Side effects:
- GI
- Short-term elevated liver enzymes (indicate inflammation or damage to liver cells)
- Rhabdomylosis –> muscle breakdown –> looking for extremely dark urine (kidney processing muscle) and complains of new muscle pain (can lead to kidney failure)

Nursing considerations:
- Medication should be taken in the evening (most of cholesterol is synthesized at this time)

Medication interactions:
- Warfarin –> can make levels toxic
- E-mycin
- Grapefruit juice
- Azoles (anti-fungals)

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15
Q

Cholestryamine powder (Questran)

  • Class?
  • Location of action?
  • MOA?
  • Side effects?
  • Nursing considerations?
A

Class = Bile acid sequestrate

Location = works in the small intestine

MOA = binds to bile acids to inhibit reabsorption of cholesterol

Side effects: *Usually get better overtime
- Constipation
- Heart burn
- Bloating
- Gas
- Belching

Nursing considerations:
- Take ANY other medications 1-2 hours before or 4-6 hours after this medication
- Increase fluid intake or utilize fiber supplement for constipation

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16
Q

Colesevelam (Welchol)

  • Class?
  • Location of action?
  • MOA?
  • Side effects?
  • Nursing considerations?
A

Class = Bile acid sequestrate

Location = works in the small intestine

MOA = binds to bile acids to inhibit reabsorption of cholesterol

Side effects: *Usually get better overtime
- Constipation
- Heart burn
- Bloating
- Gas
- Belching

Nursing considerations:
- Take ANY other medications 1-2 hours before or 4-6 hours after this medication
- Increase fluid intake or utilize fiber supplement for constipation

17
Q

Niacin (Vitamin B3)

A

Often used with other lipid lowering medications
- avoids very high dosages as would be if it was prescribed alone (needs high doses to lower cholesterol)
- causes flushing and itching at high doses

Works on ALL elements of lowering cholesterol, including increasing lipase or enzyme to break down lipids

Side effects:
- Flushing
- Pruritus (itching)
- Hepatotoxicity (Liver toxicity)

18
Q

Describe the differences/distinctions between:
- Lipoproteins
- Cholesterol
- Triglycerides

A

Lipoproteins (Lipids) = proteins which transports cholesterol

Cholesterol = fat-like, waxy substance used to build cells and certain hormones
- comes from food + liver

Triglycerides = store unused calories and provide the body with energy (too much can cause hardening or thickening of artery walls)

19
Q

Gemfibrozil (Lopid)
- Class?
- MOA?
- Side effects?
- Medication interactions?
- Rare, serious side effect?

A

Class = Fibric acid derivative

Work to:
- lower triglycerides
- increases lipase (breakdown of lipoproteins); increase excretion of cholesterol
- blocks synthesis of cholesterol in liver
do NOT do anything to lower LDL

Side effects:
- GI (diarrhea; nausea)
- Increased risk for gall stones
- Increased liver enzymes

Medication interactions:
- Anticoagulants –> can enhance effects

20
Q

Fenofibrate (Tricor)
- Class?
- MOA?
- Side effects?
- Medication interactions?
- Rare, serious side effect?

A

Class = Fibric acid derivative

Work to:
- lower triglycerides
- increases lipase (breakdown of lipoproteins); increase excretion of cholesterol
- blocks synthesis of cholesterol in liver
do NOT do anything to lower LDL

Side effects:
- GI (diarrhea; nausea)
- Increased risk for gall stones
- Increased liver enzymes

Medication interactions:
- Anticoagulants –> can enhance effects

Rare, serious side effect:
- Pulmonary embolism *need to be performing good respiratory assessments

21
Q

Ezetimbibe (Zetia)

  • Class?
  • MOA?
  • Side effects?
  • Nursing Implications?
A

Class = cholesterol absorption inhibitor

MOA:
- inhibits cholesterol from being absorbed in the small intestine
- lower LDLs
- lower triglycerides
- increase HDLs

Side effects:
- Liver functioning (decreased; damage)
- Pancreatitis (inflammation/swelling of the pancreas)
- Rhabdomyolysis - if in combination with “statin” medications

Nursing implications:
- Need liver functioning tests
- Amylase and Lipase levels indicative of pancreatitis
- lower extremity assessment
- urine color assessment

N317: Pharmacology (7 decks)

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