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Pharm > Antidysrhythmic, cholesterol, angina, & anticoagulant drugs > Flashcards

Antidysrhythmic, cholesterol, angina, & anticoagulant drugs Flashcards

1
Q

Lidocaine therapeutic use

sodium channel blocker

A

IV only

ventricular dysrhythmias, sustained ventricular tachycardia

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2
Q

Lidocaine MOA

A

blocks cardiac sodium channels

  • Slowed conduction in the atria, ventricles, and His-Purkinje system
  • Reduces automaticity in the ventricles and His-Purkinje system
  • Accelerates repolarization
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3
Q

adverse effects of lidocaine

A

CNS effects
drowsiness, confusion, paresthesia’s

Tingling & burning

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4
Q

Nurse education/Patient teaching for lidocaine

A
  • When lidocaine is used equipment for resuscitation must be available
  • To avoid toxicity dose should be reduced in patient with impaired liver or renal blood flow
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5
Q

Amiodarone therapeutic use

A

Potassium Channel Blocker (PO & IV)

  • Only approved for life threatening Ventricular Dysrhythmias due to lung damage and visual impairments
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6
Q

Amiodarone MOA

A
  • Blocks cardiac potassium channels
  • Delay repolarization in the heart
  • Prolong the action potential duration and ERP
  • Prolong the QT interval
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7
Q

drug//food interaction for Amiodarone

A
  • Do not eat grapefruit (increases drug levels)
  • Increases levels of many other dugs (digoxin, warfarin, diltiazem, statins)
  • Used with diuretics can cause dysrhythmias (K and Mag levels)
  • Cholestyramine, St. John’s wort, rifampin (reduces drug levels)
  • Beta blockers, verapamil, or diltiazem causes bradycardia
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8
Q

adverse effect of Amiodarone

A
  • Pulmonary toxicity
  • Pneumonitis and pulmonary fibrosis
  • Cardiotoxicity
  • Sinus bradycardia

Visual

  • Corneal microdeposits (photophobia and blurred vision
  • Optic neuropathy (can lead to blindness)

Thyroid toxicity

  • Causes hypothyroidism or hyperthyroidism
  • Liver injury

Dermatologic reaction (photosensitivity)

Toxic in pregnancy and breastfeeding (highly lipid soluble)

GI side effects: N/V, anorexia

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8
Q

Nurse education/Patient teaching for Amiodarone

A
  • Very long half-life (25-110 days)
  • Monitor TSH for thyroid function
  • Monitor liver enzymes and for s/s of liver injury (anorexia, n/v, malaise, fatigue, itching, jaundice, and dark urine)
  • Monitor for s/s of pulmonary toxicity (wheezing, crackles throughout lungs, SOB, cough)
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9
Q

propanolol therapeutic use

A

beta adrenergic blocker

atrial fibrillation, sinus tachycardia, supraventricular tachycardia

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10
Q

propanolol MOA

A

Blocks action on Beta receptors
* Has effects on the heart and ECG:
* Decreased automaticity of the SA Node
* Decreases velocity of conduction through the AV Node
* Decreases myocardial contractility by blocking Ca channels

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11
Q

propanolol adverse effects

A

Beta1 and Beta2 receptors are primarily on the
heart (B1) and lungs (B2)

Can cause:
* Heart block
* Exacerbate HF
* Sinus arrest
* Hypotension
* Bronchospasm (exacerbate asthma or COPD)

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12
Q

nursing implications for propanolol

A
  • Always monitor BP and HR with Beta blockers
  • Caution when giving to asthmatic patients

Contraindicated in patients with
* Sinus bradycardia
* High degree heart block
* HF

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13
Q

digoxin (IV and PO) therapeutic use

A

supraventricular dysrhythmias; primary used for heart failure

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14
Q

digoxin MOA

A

Slows conduction time through the A-V node
Effects on the heart and ECG:
* Decreases automaticity in the SA node
* Slows conduction through the AV node
* Prolongation of PR interval

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15
Q

adverse effects of digoxin

A

Cardiotoxicity: Can cause ventricular dysthymias
GI: Anorexia, n/v, abdomen discomfort
CNS: Fatigue, visual disturbances

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16
Q

nursing implication for digoxin

A
  • Monitor potassium levels closely while taking digoxin to avoid dysrhythmias
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17
Q

Adenosine therapeutic use

A
  • termination of paroxysmal SVT only
  • including Woff-Parknson-Wite syndrome
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18
Q

adenosine MOA

A

Slows conduction time through the A-V node

Effects on the heart and ECG:
* Decreases automaticity in the SA node
* Slows conduction through the AV node
* Prolongation of PR interval

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19
Q

adenosine adverse effects

A
  • Asystole
  • Sinus bradycardia
  • Dyspnea
  • Hypotension
  • Facial flushing
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20
Q

adenosine nursing implication

A

Short half live and must be given IV (<1 minute half-life)

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21
Q

HMG-CoA Reductase

Atorvastatin & Simvastatin therapeutic uses

A

treats dyslipidemia

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22
Q

Atorvastatin & Simvastatin MOA

A

Block the active site of the first (and most important) enzyme in the mevalonate pathway, HMG-CoA reductase

Inhibition of this site prevents substrate access, thereby blocking the conversion of HMG-CoA to mevalonic acid (to make cholesterol)

Leads to
o Reduction of LDL cholesterol
o Elevation of HDL cholesterol
o Reduction of triglyceride levels

Non-lipid benefits on CV actions:
o Reduce the risk of CV events

o Increased bone formation decreasing risk of osteoporosis related fractures

o Thought to help prevent DM and Alzheimer’s

23
Q

Atorvasatin & simvastatin adverse effects

A

Common: HA, rash, GI disturbances (gas and constipation)

  • Hepatotoxicity; Statins can cause liver injury

Serious: Myopathy and rhabdomyolysis

  • Statins can injure muscle tissue and cause muscle pain. Signs and symptoms include muscle aches, tenderness, or muscle weakness

Myositis: muscle inflammation

rhabdomyolysis: muscle disintegration or dissolution

Rare: Cataracts, peripheral neuropathy, Reversible memory loss or confusion

Pregnancy category X

Drug interactions:
* Other lipid lowering drugs (increased risk of adverse effects)
* Drugs that inhibit CYP3A4 (can raise levels of the statins)

24
Q

nusing implications//pt treatment for *

A
  • 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
25
Q

nitroglycerin therapeutic use

A

angina

26
Q

nitroglycerin MOA

A

drug choice for angina (vasodilator)

27
Q

nitroglycerin side affects// drug interactions

A
  • 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)

28
Q

nitroglycerin nursing implication// pt teaching

A
  • 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
29
Q

Heparin unfractionated

A

Rapid acting anticoagulant

30
Q

Heparin side effects

A
  • 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

31
Q

heparin nursing implication// pt education

A

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

32
Q

heparin// anticoagulant MOA/ therapeutic use

A
  • Reduce formation of fibrin in the coagulation cascade
  • Prevent venous thrombin and further growth of clot

All anticoagulants Therapeutic uses:
* Thrombosis, DVT, PE, MI

33
Q

Enoxaparin adverse effects

A

bleeding & thrombocytopenia

34
Q

Enoxaparin nursing implication

A
  • 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

35
Q

warfarin side effects

A

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

36
Q

warfarin nursing implications// pt teaching

A

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

37
Q

antiplatelets

A

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

38
Q

clopidgrel adverse effects//pt implication

A

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

39
Q

nursing implication// pt teaching for clopidogrel

A

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

40
Q

Aspirin MOA

A
  • Inhibition of platelet aggregation
  • Causes irreversible inhibition of cyclooxygenase, an enzyme required by platelets for clotting.
41
Q

Aspirin adverse effects

A
  • Increased risk of GI bleed
  • Hemorrhagic stroke
42
Q

Aspirin nursing implication// adverse effects

A
  • 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
43
Q

thrombolytic

A
  • Promote lysis of newly formed thrombi
  • All thrombolytic therapy is most effective when started within 4-6 hours of symptom onset
44
Q

Alteplase & Streptokinase

A

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

45
Q

Alteplase & Streptokinase adverse effects// contraindications

A

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

46
Q

nursing implication// pt education for Alteplase & Streptokinase

A

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

47
Q

Anticoagulant therapy

A
  • Subcutaneous low molecular weight heparin
  • Enoxaparin (Lovanox)
  • Direct thrombin inhibitors
  • Bivalirudin (Angiomax)
  • Factor Xa inhibitors
  • Fondaparinux (Arixtra)
48
Q

Antiplatelet therapy

A
  • 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)
49
Q

ACE inhibitor

A

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

50
Q

IV morphine sulfate

A

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

51
Q

Beta blocker

A
  • First dose via IV if chest pain is ongoing
  • Use nondihydropyridine CCC if BB are contraindicated
52
Q

Nitroglycerin

A

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

53
Q

unstable angina

A

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
54
Q

variant angina

A
  • 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 sleepTreatment 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 spasmCalcium channel blockers
  • Relaxes coronary vasospasm** Organic nitrates**
  • Relaxes coronary vasospasmBeta blockers are not effective in variant angina

Pharm (11 decks)

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