Cardiac Flashcards
What are the 3 goals of pharmacology with stable angina
Relieve Chest pain
Reduce hyperlipidemia
Improve morbidity & mortality
4 classes to relieve chest pain in stable angina
Nitrates
Beta Blockers
Calcium Channel blockers
Ranolazine
3 classes to reduce hyperlipidemia in stable angina
-statins
aspirin
clopidogrel
2 classes to imporve morbidity & mortality in stable angina
ACE inhibitor
ARB
Nitrates mechanism of relief in stable angina
Dilates veins, which decreases preload
beta blockers mech of relief in stable angina
decrease heart rate and contractility
calcium channel blockers mech of relief in stable angina
Dilate arterioles, which decreases afterload
decrease HR and contractility
Ranolazine mech of relief in stable angina
helps the myocardium generate energy more efficiency
MOA of Nitroglycerin
Dilates veins
Decreases preload
A/E of Nitroglycerin (4)
R/T vasodilation: H/A hypotension reflex tachycardia Tolerance
4 types of Nitroglycerin drugs
Rapid - nitrostat - SL
SA- transderm- skin patch
SA -Nitro-Bid - ointment
LA - Isosorbide - SL/Oral (Prevention)
Nursing Implications with Nitrates
- Monitor for headache
Mild analgesic
Most h/a subside in 20 min - Apply nitro patches in the morning and remove in the evening
Apply to hairless site and rotate sites
3.Pt Ed: Treatment of acute chest pain Take only as many SL tablets as needed - TOLERANCE Use SL form – do not swallow Fall Precautions –dizziness/hypotension No relief in 5 min – call 911
Ok to take a second SL tab in 5 min and a third in 5 more min – do not exceed 3 doses
- IV form
Glass bottle with special tubing
Monitor for severe h/a, h/a, and tachycardia - Long acting forms - taper when d/c to prevent increased chest pain from vasospasm
Nitrate interactions
Severe hypotension when taken with:
sindenafil/Viagra, antihypertensives, and ETOH
MOA of ranolazine
unknown
Possibly helps the myocardium use energy more efficiently
Warnings with ranolazine
Prolong the QT interval
Acute renal failure (existing renal disease)
Liver cirrhosis
A/E ranolazine
Headache,
dizziness
Nausea
constipation
CYP340 inhibitor– avoid grapefruit juice and other medications that are CYP inhibitors
7 classes used in treatment of Heart Failure
ACE inhibitors or ARBs, ARNI Beta blockers Mineralocorticoid Receptor Antagonist (MRAs) SLGT2 Inhibitors Diuretics Digitalis Nitrates
RAAS inhibitors in HF (3)
ACE 1
ARB
ARNI
Angiotensin receptor neprilysin inhibitor DRUG
sacubitril/valsartan
MOA of ARNI
Decreases preload & afterload, suppresses aldosterone, favorably impact cardiac remodeling
A/E of ARNI
hypotension
hyperkalemia
cough (ACE1)
Beta blocker used in HF
carvedilol
blocks beta and alpha
MOA of carvedilol
Protects against SNS activation and dysrhythmias, reverses cardiac remodeling
A/E of carvedilol
Fluid retention or worsening HF
Fatigue
Hypotension
Bradycardia
Mineralocorticoid receptor antagonist
spironolactone
MOA of spironolactone in HF
suppression of sodium/water retention to help with offloading the LV
what to watch for in spironolactone
Must watch carefully for hyperkalemia and worsening renal failure
SLG2 inhibitor in HF
dapaglifozin
dapaglifozin action in HF
Thought to help with ventricular unloading through natriuresis/osmotic diuresis without actually depleting volume like traditional diuretics
May affect cardiac metabolism/bioenergetics
first line diruetic in HF
furosemide (Lasix)
A/E of furosemide
Hypokalemia
Hypotension
Digoxin toxicity
inotropic drug and class
digitalis
cardiac glycoside
MOA of digitalis
s sodium-potassium ATP pump causing calcium to collect within the cells of the heart helping to increase myocardial contractility.
Increases blood flow to the kidney helping with excretion of sodium and water
Decreases sympathetic action and increases parasympathetic action= Decreased HR
A/E of digitalis
Cardiac dysrhythmias
Digitalis toxicity
Who is at risk of digitalis
older age
women
combo drugs with diuretics
prevent digitalis toxicity
reduce dose
monitor levels
potassium supplemental
S/S of digitals toxicity (7)
Bradycardia Headache Dizziness Confusion Nausea Visual disturbances- blurry/yellow vision
caution with digitals
Take apical pulse for a FULL minute prior to administering digoxin
Hold if pulse below 60 bpm
Monitor cardiac rhythm
ANTIDOTE for digitalis toxicity
Digoxin immune Fab (Digibind) given IV
MOA of amiodarone
prolongs the action potential duration and the effective refractory period in all cardiac tissues; blocks alpha- and beta-adrenergic receptors in the SNS
A/E of amiodarone
LOTS of adverse effects (75% have adverse effects); thyroid alterations, corneal microdeposits
Pulmonary toxicity= fatal in 10% of patients
black box warning for amiodarone
Black box warning: pulmonary toxicity, hepatotoxicity, and pro-arhythmic effects
2 sig drug interactions with amiodarone
digoxin and warfarin
Increase digoxin levels by 50%
And increase INR by 50-100%
Warnings with amiodarone
EXTREMELY long half-life– last in system many days
If someone has adverse effects, may take 2-3 months for them to fully go away
Contraindicated in people with severe bradycardia, or heart blocks (type of rhythm)
Class of Atropine for sinus brady
Anticholinergic/Antimuscarinic
MOA of Atropine
Poisons the vagus nerve; inhibits postganglionic acetylcholine receptors and direct vagolytic action
A/E of atropine
xerostomia, blurry vision, photophobia, tachycardia, flushing, hot skin
nursing implications of atropine
Need to be on cardiac monitoring, if doesn’t work quickly, give a second dose
Given IV push ONLY for bradycardia; 1mg every 3-5 minutes, 3mg MAX
adenosine MOA
slows the conduction time through the AV node
what is adenosine used for
PSVT - Paroxysmal supraventricular tachycardia
S/E of adenosine
Commonly causes a short burst of asystole until sinus rhythm returns
route of adenosine
Only given IV
Nursing implications with Adenosine
VERY SHORT HALF LIFE
Always follow with rapid normal saline flush or 2 saline flushes
class of Dofetilide
antidysrhythmic
indications of dofetilide
conversion from afib/aflutter to NSR
MOA of dofetilide
selectively blocking the rapid cardiac ion channel carrying potassium currents
S/E of Dofetilide
TORSADES, SVT, headache, dizziness, chest pain
Nursing Implications of Dofetilide
started in-hospital with ECG monitoring due to risk of Torsades (black box warning);
don’t give to patients with long QT intervals or other drugs that may prolong QT interval
6 classes that control heart rate and rhythm
Beta blockers Calcium Channel Blockers Amiodarone Adenosine Atropine Dofetilide
