Cardiac Flashcards by Jacob Lucas

What are the 3 goals of pharmacology with stable angina

Relieve Chest pain

Reduce hyperlipidemia

Improve morbidity & mortality

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4 classes to relieve chest pain in stable angina

Nitrates
Beta Blockers
Calcium Channel blockers
Ranolazine

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3 classes to reduce hyperlipidemia in stable angina

-statins
aspirin
clopidogrel

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2 classes to imporve morbidity & mortality in stable angina

ACE inhibitor

ARB

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Nitrates mechanism of relief in stable angina

Dilates veins, which decreases preload

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beta blockers mech of relief in stable angina

decrease heart rate and contractility

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calcium channel blockers mech of relief in stable angina

Dilate arterioles, which decreases afterload

decrease HR and contractility

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Ranolazine mech of relief in stable angina

helps the myocardium generate energy more efficiency

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MOA of Nitroglycerin

Dilates veins

Decreases preload

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A/E of Nitroglycerin (4)

R/T vasodilation:
H/A
hypotension
reflex tachycardia
Tolerance

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4 types of Nitroglycerin drugs

Rapid - nitrostat - SL
SA- transderm- skin patch
SA -Nitro-Bid - ointment
LA - Isosorbide - SL/Oral (Prevention)

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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

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Nitrate interactions

Severe hypotension when taken with:

sindenafil/Viagra, antihypertensives, and ETOH

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MOA of ranolazine

unknown

Possibly helps the myocardium use energy more efficiently

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Warnings with ranolazine

Prolong the QT interval
Acute renal failure (existing renal disease)
Liver cirrhosis

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A/E ranolazine

Headache,
dizziness
Nausea
constipation

CYP340 inhibitor– avoid grapefruit juice and other medications that are CYP inhibitors

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7 classes used in treatment of Heart Failure

ACE inhibitors or ARBs, ARNI
Beta blockers
Mineralocorticoid Receptor Antagonist (MRAs) 
SLGT2 Inhibitors 
Diuretics
Digitalis
Nitrates

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RAAS inhibitors in HF (3)

ACE 1
ARB
ARNI

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Angiotensin receptor neprilysin inhibitor DRUG

sacubitril/valsartan

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MOA of ARNI

Decreases preload & afterload, suppresses aldosterone, favorably impact cardiac remodeling

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A/E of ARNI

hypotension
hyperkalemia
cough (ACE1)

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Beta blocker used in HF

carvedilol

blocks beta and alpha

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MOA of carvedilol

Protects against SNS activation and dysrhythmias, reverses cardiac remodeling

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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 ```