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Pharamacology > Cardiac > Flashcards

Cardiac Flashcards

1
Q

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

A

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

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2
Q

If the prescriber was to discontinue propranolol for any reason, how should this be done?

A

Beta blockers should not be withdrawn suddenly for any reason.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

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3
Q

Identify the common indications for use of Digoxin

A

Heart failure, arrhythmias

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4
Q

List common ADRs and interventions for digoxin

A

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

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5
Q

What are common drug interactions that impact on digoxin

A

Diuretics - alter electrolyte balance
Potassium depleting drugs - increase risk of digoxin toxicity
Calcium channel blockers enhance plasma concentration of digoxin

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6
Q

What must nurses so before administering Digoxin and why

A

Must check apical pulse prior to administering and checking rate and rhythm, monitor potassium levels

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7
Q

What are contraindications for Digoxin ?

A

Acute MI
Hypersensitivity to drug
Ventricular fibrillation

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8
Q

Digoxin has a very narrow therapeutic index and a very long half life, what are the possible clinical indications of this?

A

Long half life - takes. time to achieve steady state
Narrow therapeutic index - need to monitor for digoxin toxicity and potassium levels

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9
Q

You will need to explain Digoxin toxicity, how it happens, signs and symptoms and treatments

A

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

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10
Q

What is the MOA of Digoxin

A

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

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11
Q

Identify common indications for nitrates (GTN spray)

A

To prevent or treats stable angina, unstable angina and heart failure associates with acute MI
Most commonly used to prevent angina

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12
Q

Patient education for Nitrates (GTN spray)

A

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

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13
Q

Common drug interactions with GTN spray

A

Other substance that may also cause vasodilation my enhance the orthostatic hypotensive effects e.g alcohol, antihypertensives, treatment for erectile dysfunction

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14
Q

Common ADRs for GTN spray

A

Postural hypotension, dizziness, fainting, headache, nausea, vomiting, dry mouth, blurred vision, facial flushing, tachycardia

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15
Q

What is the MOA of GTN spray

A

Binds to nitrate receptors in vascular smooth muscles - relaxation causing Venodilation and Vasodilation of arteries increasing coronary perfusion, increase oxygen delivery to myocardium

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16
Q

Generic drug names for nitrates

A

GTN spray - sublingual spray, tab, patch , IV
Isosorbide tab and sublingual tab

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17
Q

Name generic drugs of Ace inhibitors

A

Enalapril
Quinapril
Cilizapril
(any other drug ending in pril)

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18
Q

What should be monitored when taking Ace inhibitors

A

Monitor BP and renal function

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19
Q

What are some common ADRs for Ace inhibitors?

A

headache, nausea, dizziness, weakness, hypotension, loss of taste, rash ,fever, joint pain
Dry persistent cough
Rare but potentially fatal - angio-oedema

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20
Q

List any common drug interactions with Ace inhibitors

A

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

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21
Q

Contraindications / precautions of ACE inhibitors

A

Avoid use in person with ACEi hypersensitivity, hx of angio-oedema, hyperkalaemia, renal impairment
Avoid use in pregnancy

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22
Q

Patient education with Enalapril

A

Info on ADRs
Monitor BP
Not to take over the counter NSAIDS
Dietary advice K+ rich foods to avoid

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23
Q

Common indications for Enlapril

A

Hypertension, heart failure, left ventricular dysfunction following MI
Diabetic nephropathy

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24
Q

What is the MOA of Enalapril

A

Blocks the enzyme required for converting angitension 1 to 2 resulting in decreased vascular tone

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25
Q

What is the MOA of Aspirin

A

Inhibits COX1 which inhibits platelet aggregation and vasoconstriction Aspirin binds to the platelet for the life of the platelet

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26
Q

What is a common indication for Aspirin

A

Prevention of arterial thrombosis

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27
Q

Aspirin ADRs

A

Bleeding, bruising, GI bleeding, dyspepsia

28
Q

Aspirin contraindications

A

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

29
Q

Aspirin patient education

A

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

30
Q

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

A

Because it is an antiplatlet it inhibits platelet aggregation and helps to prevent development of further atherosclerotic plaques which decreases risk of another MI

31
Q

Generic names for statins

A

Simvastatin
Atorvastatin
Pravastatin

32
Q

Common indicators for use of statins

A

When there is a considerable risk of CVD
Prevent atherosclerosis in persons with hyperlipidaemia/dyslipidaemia

33
Q

Common ADRs for statins

A

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

34
Q

Common drug interactions for statins

A

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

35
Q

Contraindications for statins

A

liver disease, severe renal impairment, pregnancy and lactation

36
Q

Monitoring considerations for nurses with statins

A

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

37
Q

Patient education for statins

A

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

38
Q

What is the MOA of statins

A

Inhibit the synthesis of cholesterol in the liver by inhibiting the HMG-CoA reductase enzyme

39
Q

What are some common anticoagulant

A

Heparin and Warfarin

40
Q

What are the ADRs of heparin

A

Bleeding and bruising
Lipohypertrophy
Thromocytopenia is a rare ADR

41
Q

Patient education for Heparin

A

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

42
Q

What are some common drug interactions and monitoring for Heparin

A

Avoid concurrent use with other drugs that impact coagulation - this includes aspirin
Require regular monitoring only for heparin

43
Q

What are some contraindications for heparin

A

Hemorrhagic conditions
Not recommended in pregnancy
renal failure

44
Q

What is the MOA for heparin

A

inactivates factor Xa & factor II (inhibits 2 factors) resulting in inhibition of thrombin and preventing fibrin clot formation.

45
Q

Identify common indications for Heparin

A

Used for prevention of and treatment of venous thromembolism, formation of clots in IV catheters, dialysis. Shorter half life - used in acute settings

46
Q

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

A

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

47
Q

Identify common indications for warfarin

A

For prevention of existing clots and prevention of DVT, PE, thrombi associated with prosthetic heart valves, chronic AF

48
Q

Warfarin ADRs

A

bleeding, dyspnoea, headache, chest pain, dizziness, GI upset, visual disturbances

49
Q

Contraindications for warfarin

A

History or hemorrhagic condition, hx gastric ulceration, alcoholism, elderly, pregnancy

50
Q

Monitoring warfarin

A

Require regular INR tests and drug adjustments depending on INR
Relatively long half - life
Narrow therapeutic range

51
Q

Patient education of warfarin

A

Risk of bleeding - look for signs of GI bleeding
Regular monitoring
Same time everyday
Avoid vit k rich foods
Care with pregnancy

52
Q

What is the MOA for warfarin

A

Inhibits the synthesis of Vit K dependent clotting factors

53
Q

Generic names of beta blockers

A

Selective - metoprolol
Non-selective- propranolol

54
Q

What are some contraindications for beta blockers

A

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

55
Q

Monitoring considerations for nurses with pts using beta blockers

A

Vital signs (apical pulse to check rhythm
Monitor BGL if indicated
Peripheral circulation checks (COWSCAMP

56
Q

Common beta blocker ADRs

A

Cardiac - bradycardia, hick can exacerbate HF - dizzy, postural hypotension due to peripheral vasodilation
Resp - bronchospasm, COPD, asthma
CNS - fatigue, insomnia, depression
Endocrine - decrease BGL

57
Q

Common drug interactions with beta blockers

A

NSAIDs - may reduce effect on BP
MAOi - result in severe hypotension and bradycardia
Ca2+ channel blockers - enhances cardiac depressant effects resulting in bradycardia

58
Q

Common indicators for beta blockers and why beta blockers are used for these indications

A

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

59
Q

Patient education for beta blockers

A

Why person is taking this drug
Falls risk due to postural hypotension
Start low go slow - prevent onset of ADRs

60
Q

If Mr Jones has been prescribed propranolol and salbutamol what might happen?

A

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

61
Q

What is the MOA of beta blockers

A

Binds to β receptors in the autonomic nervous system and prevents the catecholamines (adrenaline / noradrenaline) from stimulating the receptors and resultant sympathetic response.

62
Q

What is the MOA of Furosemide

A

Inhibit reabsorption of sodium, chloride, and other electrolytes predominantly from the ascending limb of the loop of Henlé in the renal tubule

63
Q

What are the ADRs of furosemide

A

Dehydration & electrolyte imbalance, dizziness, postural hypotension

64
Q

Contraindications for Furosemide

A

Severe hypokalaemia
Renal failure due to nephrotocis or hepatotoxic drugs

65
Q

Patient education for Furosemide

A

Take at the same time everyday
Drink lots of water to maintain hydration

Pharamacology (9 decks)

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