Antidysrhythmic, cholesterol, angina, & anticoagulant drugs Flashcards

Question

nusing implications//pt treatment for *

Answer 1

* Give statins in the evening * Statins are the most effective drug for lowering LDL and total cholesterol * Used in combination with therapeutic lifestyle changes: * The TLC diet (decrease cholesterol and saturated fats; no trans fats) 1. Exercise 2. Smoking cessation 3. Weight control * Treatment is usually continued lifelong * Monitor LFTS before and during treatment (at least every 6 months) * Educate patient to report s/s of memory issues * Educate patient to reports s/s of muscle injury and monitor creatine kinase CK levels An enzyme released from injured muscles

Answer 2

drug choice for angina (vasodilator)

Answer 3

* All secondary to vasodilation * Headache * Orthostatic hypotension * Reflex tachycardia **Drug interactions:** * Hypotensive drugs * Beta blockers verapamil and diltiazem * Phosphodiesterase type 5 inhibitors * Sildenafil (Viagra), Tadalafil (Cialis)

Answer 4

* Long-acting preparations (transdermal patches, topical ointment, sustained release oral tablets, or capsules) should be discontinued slowly * Do not use in patients who are taking phosphodiesterase type 5 inhibitors like Sildenafil (Viagra). * Use with caution in hypotensive patient or someone taking BP lowering meds * Instruct to place under tongue and leave there until fully dissolved * If pain not relieved then take another Nitro in 5 min. x2. (total of 3 times) and call 911 * Store tabs in dark, tightly closed bottle, discard after 24 months * Patches: apply to hairless area, remove after 12 hours to allow for 10-12 patch free hours to help minimize tolerance. * Spray: Directly at oral mucosa * Buccal: Place between lip and gum – will dissolve over 3-5 hours. * Inform pt. headache (HA) is common S/E due to vasodilatation and will diminish over time with use of med. Treat HA with Tylenol if needed. * Warn of hypotension and what to do * Avoid use of alcohol and stop smoking * Tolerance of Nitrates does occur although less likely with SL route

Answer 5

Rapid acting anticoagulant

Answer 6

* Heparin induced thrombocytopenia (HIT)- hypersensitivity reactions * Immune response causing low platelet counts leading to the development of antibodies against heparin platelet protein complexes * Increases risk of DVT, PE, cerebral thrombosis * Diagnosed when platelet counts fall significantly, or thrombus occurs **Contraindications:** * Patients with thrombocytopenia * Uncontrolled bleeding * Post-op brain, eye, or spinal cord surgery

Answer 7

**Should be used for** * DVT, PE, DIC * Prevent thrombus formation in patients with atrial fib or MI * Surgery * Intrabdominal, orthopedic, open heart * IV or SQ only **Nurse education** * When administering heparin subcutaneously injected into the abdomen using a small needle (25-28 g) * Do not aspirate or rub the injection site * Monitor for signs of bleeding * Bleeding gums, bruises, nosebleeds, hematuria, hematemesis, occult blood in the stool, and petechiae * Monitor labs for Thrombocytopenia (PLT)- Platelet count * Antidote for overdose =Protamine sulfate **Lab monitoring** * Activated partial thromboplastin time (aPTT) * Normal is 40 seconds * Therapeutic index is 1.5 to 2x normal making it 60 to 80 seconds

Answer 8

* Reduce formation of fibrin in the coagulation cascade * Prevent venous thrombin and further growth of clot **All anticoagulants Therapeutic uses:** * Thrombosis, DVT, PE, MI

Answer 9

bleeding & thrombocytopenia

Answer 10

* Prevention of DVT following surgery * Treatment of established DVT * Prevention of ischemic complications (MI) **Nurse education:** * Weight based dosing * Given SQ only * fixed dosing and does not require monitoring blood levels such as eight aPPT and can be given at home

Answer 11

vitamin K antagonist **Adverse effects:** * Hemorrhage * Fetal hemorrhage * Teratogenesis when used during pregnancy **Drug contraindications:** * Allopurinol (Zyloprim) * Cimetidine (Tagament) * Corticosteroids * NSAIDs * Oral hypoglycemic agents * Phenytoin (Dilantin) * Salicylates * Sulfonamides

Answer 12

**Should be used for:** * Long term anticoagulation * Prevention of Pulmonary embolism caused by DVT * Prosthetic heart valves * Chronic atrial fibrillation * After MI **Nurse education** * Watch for medication incompatibilities * Keep appointments for lab work and follow up exams * Report planned or known pregnancy * Take the drug exactly as prescribed * Do not take over the counter or herbal medications without speaking to a prescriber * Do not eat large amounts of green leafy vegetables and foods high in vitamin K decreases effectiveness of the drug **Antidote for toxicity** * Vitamin K **Lab Monitoring** * PT/INR normal 18-24/2-3 * PT normal 12 seconds * Therapeutic index is 1.5 to 2x normal

Answer 13

**inhibit platelet aggregation & prevent arterial thrombus** **All antiplatelet education:** * Should not be used in patients who have bleeding disorders * Take medication with food if GI upset occurs * Monitor for side effects related to bleeding and measures to prevent bleeding **All antiplatelet side effects:** * Bruising * Hematuria * GI bleeding * Tarry stools Aspirin & Clopidogrel

Answer 14

Adverse effects: * Bleeding * Thrombotic thrombocytopenic purpura (TTP) * Fatal condition characterized by thrombocytopenia, hemolytic anemia, neurologic symptoms, renal dysfunction, and fever * Occurs in the first two weeks of treatment Drug interactions: * Drugs that promote bleeding * Proton pump inhibitors are used with medication to protect against GI bleeding * PPI may also reduce the antiplatelet effects of medication

Answer 15

Should be used for: * Prevent blockage of coronary artery stents * Reduce thrombotic events in patients with acute coronary syndrome and/or atherosclerosis * MI, ischemic stroke, vascular death

Answer 16

* Inhibition of platelet aggregation * Causes irreversible inhibition of cyclooxygenase, an enzyme required by platelets for clotting.

Answer 17

* Increased risk of GI bleed * Hemorrhagic stroke

Answer 18

* Reduce the risk of death and non-fatal stroke Ischemic stroke and TIAs * Reduce the risk of MI and sudden death and Chronic stable angina * Reduce the combined risk of death and non-fatal MI * Unstable angina * Prevent re-occlusion in coronary stenting * Reduce the risk of vascular mortality with acute MI * Reduce the combined risk of death and non-fatal MI with a history of previous MI * Primary prevention of MI in men and women aged 65 years and older

Answer 19

* Promote lysis of newly formed thrombi * All thrombolytic therapy is most effective when started within 4-6 hours of symptom onset

Answer 20

Binds with plasminogen to plasmin, an enzyme that digest the fibrin meshwork of clots

Answer 21

**Adverse effects:** * Bleeding * Antibody production * Hypotension * Fever * Not for long term use **Contraindications:** * In patients with a history of uncontrolled hypertension * History of the thoracic, pelvic, or abdominal surgery in the previous 10 days * History of hepatic or renal disease * Recent prolonged cardiopulmonary resuscitation

Answer 22

**Should be used only for:** * Acute coronary thrombosis (acute MI) * Start within 4-6 hours of symptom onset * Massive pulmonary emboli * Acute ischemic stroke **Nurse education:** * Monitor for hypotension and tachycardia * Monitor for symptoms of increased bleeding * Avoid injections * apply direct pressure over a puncture site for 20 to 30 minutes * handle the patient as little as possible when moving * Discontinue the medication if bleeding develops and notify the physician * Educate and instruct the patient and measures to prevent bleeding

Answer 23

* Subcutaneous low molecular weight heparin * Enoxaparin (Lovanox) * Direct thrombin inhibitors * Bivalirudin (Angiomax) * Factor Xa inhibitors * Fondaparinux (Arixtra)

Answer 24

* ASA- continued indefinitely * Clopidogrel (Plavix)- continued for up to 2 months * Glycoprotein IIb/IIIa inhibitors * Only if angioplasty is planned- Abciximab (ReoPro) * If angioplasty is not planned and only in high-risk patients with continued ischemia- Eptifibatide (Integrilin) or tirofiban (Aggrastat)

Answer 25

For patients with left ventricular dysfunction or congestive heart failure Can substitute ACE with ARB

Answer 26

If pain is not relieved immediately by nitroglycerin, or if pulmonary congestion// severe agitation is present

Answer 27

* First dose via IV if chest pain is ongoing * Use nondihydropyridine CCC if BB are contraindicated

Answer 28

Give 3 doses sublingually every 5 minutes (tablet or spray) and follow with IV therapy if persistent ischemia or hypertension

Answer 29

**A medical emergency, symptoms result from severe CAD complicated by visa spasm, platelet aggregation, and transient coronary thrombi or emboli** * Unstable angina poses a much greater risk of death * Unstable angina left untreated can lead to a MI * Symptoms may include angina at rest, new onset exertional angina, or intensification of existing angina **Treatment strategies** * Goal is to reduce pain and prevent progression to MI or death, all patients should be hospitalized * * Acute management consists of anti-ischemic therapy combined with antiplatelet and anticoagulation therapy

Answer 30

* Caused by coronary artery spasm where blood flow is restricted to the myocardium * Pain is secondary to insufficient oxygenation of the heart Variant angina can produce pain at any time even during rest and sleep **Treatment strategy** * Goal is to reduce the incidence and severity of attacks by increasing cardiac oxygen supply * This is due to pain being caused by a reduction in oxygen supply rather than by an increase in demand * Vasodilators (oxygen supply is increased with vasodilators) Which prevent or relieve coronary artery spasm **Calcium channel blockers** * Relaxes coronary vasospasm ** Organic nitrates** * Relaxes coronary vasospasm **Beta blockers are not effective in variant angina**