Cardiac Flashcards
If Mrs Smith is administered a second drug that is known to inhibit the metabolism of propranolol, what effect would this have on bioavailability and what are potential clinical consequences
The addition of a drug that inhibits propranolol metabolism will significantly affect bioavailability due to reduction in clearance resulting in increase systematic blood concentration. A dose adjustment is required
Clinical consequences = worsening plasma concentration leads to bradycardia, hypotension’s, palpating worsening HF
If the prescriber was to discontinue propranolol for any reason, how should this be done?
Beta blockers should not be withdrawn suddenly for any reason. Rapid withdrawal can result in rebound effect due to unpregulation of adrenergic receptors
Consequences may be exacerbated of hypertension, angina, dis rhythmic or MI
Dose should be reduced over 1-2 weeks
Identify the common indications for use of Digoxin
Heart failure, arrhythmias
List common ADRs and interventions for digoxin
Nausea - take with food
Dizzy, weak, tired, confused - care with driving
Allergic reaction - skin rashes, itching, swelling, difficulty breathing
Palpations - let GP know
Vomiting diarrhoea, blurred vision - may be digoxin toxicity, contact GP urgently
What are common drug interactions that impact on digoxin
Diuretics - alter electrolyte balance
Potassium depleting drugs - increase risk of digoxin toxicity
Calcium channel blockers enhance plasma concentration of digoxin
What must nurses so before administering Digoxin and why
Must check apical pulse prior to administering and checking rate and rhythm, monitor potassium levels
What are contraindications for Digoxin ?
Acute MI
Hypersensitivity to drug
Ventricular fibrillation
Digoxin has a very narrow therapeutic index and a very long half life, what are the possible clinical indications of this?
Long half life - takes. time to achieve steady state
Narrow therapeutic index - need to monitor for digoxin toxicity and potassium levels
You will need to explain Digoxin toxicity, how it happens, signs and symptoms and treatments
Results in dysrhythmia/tachycardia, GI symptoms of nausea, vomiting, diarrhoea, CNS symptoms confusion and visual symptoms
Risk factors
- dehydration - alter electrolyte balance
- hypokalaemia - potassium competes with digoxin for binding Na+/K+ enhancing the effect
- Renal failure
treatment - Digibind
What is the MOA of Digoxin
Inhibits Na+/K+ pump which induces an increase in intracellular sodium that will drive an influx of calcium in the heart and cause an increase in contractility
Identify common indications for nitrates (GTN spray)
To prevent or treats stable angina, unstable angina and heart failure associates with acute MI
Most commonly used to prevent angina
Patient education for Nitrates (GTN spray)
Tolerance - develops over time with continued stimulation of nitrate receptors= desensitised effects of GTN, increase dose =same effect
Angina action plan - ‘take 1 spray, 5 mins if still present take another’
Always carry spray/tabs
Only take when needed
Common drug interactions with GTN spray
Other substance that may also cause vasodilation my enhance the orthostatic hypotensive effects e.g alcohol, antihypertensives, treatment for erectile dysfunction
Common ADRs for GTN spray
Postural hypotension, dizziness, fainting, headache, nausea, vomiting, dry mouth, blurred vision, facial flushing, tachycardia
What is the MOA of GTN spray
Binds to nitrate receptors in vascular smooth muscles - relaxation causing Venodilation and Vasodilation of arteries increasing coronary perfusion, increase oxygen delivery to myocardium
Generic drug names for nitrates
GTN spray - sublingual spray, tab, patch , IV
Isosorbide tab and sublingual tab
Name generic drugs of Ace inhibitors
Enalapril
Quinapril
Cilizapril
(any other drug ending in pril)
What should be monitored when taking Ace inhibitors
Monitor BP and renal function
What are some common ADRs for Ace inhibitors?
headache, nausea, dizziness, weakness, hypotension, loss of taste, rash ,fever, joint pain
Dry persistent cough
Rare but potentially fatal - angio-oedema
List any common drug interactions with Ace inhibitors
Diuretics - ACE causes hyperkalaemia = K+ retention, check renal function and electrolytes
Lithium - decrease excretion of lithium which may result in lithium toxicity, check levels and renal function
NSAIDS - increase risk of hyperkalaemia and decrease effect of ACE
Contraindications / precautions of ACE inhibitors
Avoid use in person with ACEi hypersensitivity, hx of angio-oedema, hyperkalaemia, renal impairment
Avoid use in pregnancy
Patient education with Enalapril
Info on ADRs
Monitor BP
Not to take over the counter NSAIDS
Dietary advice K+ rich foods to avoid
Common indications for Enlapril
Hypertension, heart failure, left ventricular dysfunction following MI
Diabetic nephropathy
What is the MOA of Enalapril
Blocks the enzyme required for converting angitension 1 to 2 resulting in decreased vascular tone
What is the MOA of Aspirin
Inhibits COX1 which inhibits platelet aggregation and vasoconstriction Aspirin binds to the platelet for the life of the platelet
What is a common indication for Aspirin
Prevention of arterial thrombosis
Aspirin ADRs
Bleeding, bruising, GI bleeding, dyspepsia
Aspirin contraindications
Should not be used for children due to risk of Reyes syndrome
Caution in older people decrease hepatic and renal function
Avoid in persons with hemorrhagic conditions, coagulation disorders, recent surgery or trauma
Avoid with other NSAIDs and A-cog
Aspirin patient education
Only take as directed
Do not take with other over the counter NSAIDs unless discussed with GP
Must alert health professionals that they are taking antiplatlelet - risk of bleeding
Monitor for GI bleeds, dsynopea, bronchoconstriction
Mr G has had an MI and one of his meds is a low dose enteric coated aspirin. With reference to MOA of Aspirin, explain why he needs to continue taking Aspirin
Because it is an antiplatlet it inhibits platelet aggregation and helps to prevent development of further atherosclerotic plaques which decreases risk of another MI
Generic names for statins
Simvastatin
Atorvastatin
Pravastatin
Common indicators for use of statins
When there is a considerable risk of CVD
Prevent atherosclerosis in persons with hyperlipidaemia/dyslipidaemia
Common ADRs for statins
Stomach cramps, pain, constipation, diarrhoea or nausea, headache, sleep disturbances
Major ADR - myopathy or
Rhabdomyolysis - muscle destroyed and release toxins = acute renal failure
Any form of muscle weakness
Common drug interactions for statins
Grape fruit juice inhibits metabolism of drug
Simvastatin has most drug interactions
Drugs that will inhibit metabolism of statins = increase plasma concentration and increasers of rhabdomyolysis
Contraindications for statins
liver disease, severe renal impairment, pregnancy and lactation
Monitoring considerations for nurses with statins
Must have blood tests for lipid profile couple of months for the first year
Check liver and renal function for metabolism. and excretion and thyroid function
BP checks, lifestyle, smoking cessation, other factors that increase the risk for CVD
Patient education for statins
Increase exercise
Diet - decrease fat intake, focus of fruits and veggies, smaller portions
Smoking increases the risk of CVD
ADRs
Take at night for maximum effect
What is the MOA of statins
Inhibit the synthesis of cholesterol in the liver by inhibiting the HMG-CoA reductase enzyme
What are some common anticoagulant
Heparin and Warfarin
What are the ADRs of heparin
Bleeding and bruising
Lipohypertrophy
Thromocytopenia is a rare ADR
Patient education for Heparin
Need to advise other health care
Alternate site of injection to prevent bruising and lipohypertrophy
Avoid over counter aspirin and other NSAIDs
Caution with dental treatment
Monitor for signs of bleeding
What are some common drug interactions and monitoring for Heparin
Avoid concurrent use with other drugs that impact coagulation - this includes aspirin
Require regular monitoring only for heparin
What are some contraindications for heparin
Hemorrhagic conditions
Not recommended in pregnancy
renal failure
What is the MOA for heparin
inactivates factor Xa & factor II (inhibits 2 factors) resulting in inhibition of thrombin and preventing fibrin clot formation.
Identify common indications for Heparin
Used for prevention of and treatment of venous thromembolism, formation of clots in IV catheters, dialysis. Shorter half life - used in acute settings
You are looking after a patient admitted with a diagnosis of acute PE. Wither reference to MOA and half life of Aspirin, heparin and Warfarin, explain what you would expect to see prescribed for his initial pharmacology treatment
Aspirin- prevent arterial thrombus formation, inhibits platelet aggregation
Heparin - is given IV or submit, 100% bioavailability rapid onset action
Warfarin - orally, longer half life 20-60hrs - not used in acute setting, used to prevent thrombi
Identify common indications for warfarin
For prevention of existing clots and prevention of DVT, PE, thrombi associated with prosthetic heart valves, chronic AF
Warfarin ADRs
bleeding, dyspnoea, headache, chest pain, dizziness, GI upset, visual disturbances
Contraindications for warfarin
History or hemorrhagic condition, hx gastric ulceration, alcoholism, elderly, pregnancy
Monitoring warfarin
Require regular INR tests and drug adjustments depending on INR
Relatively long half - life
Narrow therapeutic range
Patient education of warfarin
Risk of bleeding - look for signs of GI bleeding
Regular monitoring
Same time everyday
Avoid vit k rich foods
Care with pregnancy
What is the MOA for warfarin
Inhibits the synthesis of Vit K dependent clotting factors
Generic names of beta blockers
Selective - metoprolol
Non-selective- propranolol
What are some contraindications for beta blockers
person with heart block - will worsen effect of heart blockers and decrease speed of conduction
Resp disease - non-selective will exacerbate bronchospasm by targeting B2 in lungs - should only use selective B1 antagonists
Diabetes - low/unstable BGL response - increase BGL
Pregnancy/lacation - mat restricts growth of uterus
Monitoring considerations for nurses with pts using beta blockers
Vital signs (apical pulse to check rhythm
Monitor BGL if indicated
Peripheral circulation checks (COWSCAMP
Common beta blocker ADRs
Cardiac - bradycardia, hick can exacerbate HF - dizzy, postural hypotension due to peripheral vasodilation
Resp - bronchospasm, COPD, asthma
CNS - fatigue, insomnia, depression
Endocrine - decrease BGL
Common drug interactions with beta blockers
NSAIDs - may reduce effect on BP
MAOi - result in severe hypotension and bradycardia
Ca2+ channel blockers - enhances cardiac depressant effects resulting in bradycardia
Common indicators for beta blockers and why beta blockers are used for these indications
angina - decrease HR and contractility of myocardium - decrease myocardial oxygen requirements
Arrhythmias - decrease conduction through atria from SA nodes to the AV node
Hypertension - decrease sympathetic response results in less vasoconstriction and decrease CO
HF - decrease overall workload of the heart
Post MI - given to decrease size of infarction, decrease arrhythmias
Patient education for beta blockers
Why person is taking this drug
Falls risk due to postural hypotension
Start low go slow - prevent onset of ADRs
If Mr Jones has been prescribed propranolol and salbutamol what might happen?
Propranolol is non-selective so would likely cause bronchoconstriction by binding to the B2 receptors in the lungs, the salbutamol would be ineffective as it would not be able to B2 receptors in the lungs
What is the MOA of beta blockers
Binds to β receptors in the autonomic nervous system and prevents the catecholamines (adrenaline / noradrenaline) from stimulating the receptors and resultant sympathetic response.
What is the MOA of Furosemide
Inhibit reabsorption of sodium, chloride, and other electrolytes predominantly from the ascending limb of the loop of Henlé in the renal tubule
What are the ADRs of furosemide
Dehydration & electrolyte imbalance, dizziness, postural hypotension
Contraindications for Furosemide
Severe hypokalaemia
Renal failure due to nephrotocis or hepatotoxic drugs
Patient education for Furosemide
Take at the same time everyday
Drink lots of water to maintain hydration
