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Cardiac and Renal Drugs Flashcards

1
Q

What is the mechanism of action of angiotensin-converting enzyme (ACE) inhibitors?

A

Blocks the conversion of angiotensin I to angiotensin II (potent vasoconstrictor and stimulator of aldosterone) by inhibiting ACE
Prevents breakdown of badykinins which leads to vasodilation
Decreases systemic vascular resistance leading to reduced BP
Inhibits aldosterone secretion preventing sodium and water reabsorption

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2
Q

What are the drug effects of angiotensin-converting enzyme (ACE) inhibitors?

A

Vasodilation (↓ afterload)
Excretion of sodium and water (↓ preload)
Prevents reabsorption of sodium and water
Renal protective
Reduce blood pressure

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3
Q

What are the indications for angiotensin-converting enzyme (ACE) inhibitors?

A

Hypertension (especially those with renal disease)

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4
Q

What are the contraindications for angiotensin-converting enzyme (ACE) inhibitors?

A

Previous reaction of angioedema

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5
Q

What are the adverse effects of angiotensin-converting enzyme (ACE) inhibitors?

A

Dry cough
First-dose syncope
Angioedema
Hyperkalemia

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6
Q

What are some examples of ACE inhibitors?

A

Lisinopril

Benzaepril

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7
Q

What is the mechanism of action of calcium channel blockers?

A

Prevents influx of calcium ion across cell membrane of vascular smooth muscle

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8
Q

What are the drug effects of calcium channel blockers?

A

Dilation of peripheral and coronary arteries and arterioles (↓ afterload)

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9
Q

What are the indications for calcium channel blockers?

A

Hypertension

Angina

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10
Q

What are the adverse effects of calcium channel blockers?

A 
Constipation
Dizziness
Hypotension
Peripheral edema
Suppression of cardiac function
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11
Q

What are some nursing implications for calcium channel blockers?

A

Monitor blood pressure and heart rate

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12
Q

What are some things to educate the patient about calcium channel blockers?

A

Change positions slowly
Avoid hazardous activities while dizzy
Increase fluid and fiber intake to prevent constipation

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13
Q

What are some examples of calcium channel blockers?

A

Amlodipine

Cardizem

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14
Q

What is the mechanism of action of glycosides?

A

Inhibits the sodium-potassium adenosine triphosphatase pump causing an accumulation of calcium within cardiac myocytes
The calcium then augments contractile force by facilitating the interaction of myocardial actin and myosin

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15
Q

What are the drug effects of glycosides?

A

Positive inotropic effect increases the force of ventricular contraction which increases cardiac output
Increased cardiac output can reverse all overt manifestations of heart failure

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16
Q

What are the indications for glycosides?

A

Second-line heart failure

Atrial fibrillation

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17
Q

What are the nursing implications for glycosides?

A

Use with precaution with Lasix (risk of hypokalemia)
Very narrow therapeutic window (0.5 - 0.8 ng/mL)
Monitor drug and potassium levels
Normal range for potassium: 3.5 - 5 mEq/L

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18
Q

What are the adverse effects of glycosides?

A

Digoxin toxicity

Cardiac dysrhythmia

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19
Q

What are the signs and symptoms of digoxin toxicity?

A

Heart rate below 60 or new irregular rhythm
Anorexia, nausea, confusion, and blurred, yellow tinged appearance of halos
Takes about 1 week for drug to be eliminated from body

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20
Q

What is the antidote for digoxin toxicity?

A

Digoxin immune fab, Digibind

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21
Q

What are some examples of glycosides?

A

Digoxin

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22
Q

What is the mechanism of action of loop diuretics?

A

Blocks reabsorption of sodium (Na) and chloride (Cl) in the ascending limb of the loop of Henle which prevents reabsorption of water

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23
Q

What are the drug effects of loop diuretics?

A

Diuresis

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24
Q

What are the indications for loop diuretics?

A

Pulmonary edema caused by heart failure

CHF

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25
What are the contraindications for loop diuretics?
End stage renal disease | Anuria
26
What are the adverse effects of loop diuretics?
``` Severe dehydration Hypotension Hypokalemia Ototoxicity Hyperglycemia Hyperuricemia ```
27
What is the mechanism of action for Thiazide diuretics (hydrochlorthiazide)?
Blocks the reabsorption of sodium and chloride in the early distal convoluted tubule, which prevents reabsorption of water. The maximum diuresis is less than the Loop Diuretics.
28
What is the indication for Thiazide diuretics (hydrochlorthiazide)?
First line treatment for hpertension
29
What are the contraindications for Thiazide diuretics (hydrochlorthiazide)?
renal insufficiency
30
What are the adverse effects for Thiazide diuretics (hydrochlorthiazide)?
Hypokalemia, hypotension, hyperglycemia, hyperuricemia, dehydrations
31
What are the nursing implications for Thiazide diuretics (hydrochlorthiazide)?
Monitor electrolytes (especially K+) Monitor BP Monitor fluid volume status
32
What is the pt edu for Thiazide diuretics (hydrochlorthiazide)?
Take early in the day to avoid nocturne, eat potassium rich foods, change position slowly, monitor weight and BP
33
What is the mechanism of action and drug effects for Niacin (niaspan)?
Lowers LDL and raises HDL. | B vit known as niacin (B3). Higher doses are needed than available in OTC vitamins
34
What are the adverse effects of Niacin (niaspan)
Intense facial flushing an pruritus | Hepatotoxicity
35
What are the nursing implications and pt edu for Niacin (niaspan)
Instruct pt to take 325 mg of ASA 30 minutes prior to dose to decrease flushing. Pt can also take extended release Niacin to not get the Asian flush
36
What is the mechanism of action for Nitrates (nitroglycerin)?
In angina caused by atherosclerosis- dilates veins to reduce venous return, decrease preload Which decreases the workload of the heart In variant angina- dilates coronary which improves blood flow through coronary vasculature
37
What is the drug effect for Niacin (niaspan)?
Treatment of acute angina attacks and prevention of angina episodes. Increased cardiac oxygen supply (variant angina). Decrease cardiac oxygen demand (atherosclerosis heart disease)
38
What are the indications for Niacin (niaspan)?
Stable, unstable, and variant angina
39
What are the adverse effects for Niacin (niaspan)?
Orthostatic hypotension Headache Reflex tachycardia Tolerance
40
What are the contraindications for Niacin (niaspan)?
ED drugs | Hypotension
41
Explain the routes for Niacin (niaspan)?
Sublingual- should burn under the tongue During acute angina attack, the pt should sit down and take one tablet. If relief does not occur within 5 minutes, call 911 and take another one. Take up to 3 doses. Patch- can be used up to 14 hours- move patch to a different place on body each day to prevent skin irritation. Remove the patch for 10-12 hours each night to reduce the risk of developing tolerance. Ointment- wear gloves and avoid touching ointment with hands
42
What are the nursing implications for Niacin (niaspan)?
Make sure they know how to use the med Identify risk factors for CAD Obtain baseline data regarding frequency, intensity, duration, location, and precipitating factors of attacks Assess v/s and EKG
43
What is the patient edu for Niacin (niaspan)?
Instruct proper techniques for administering SL, transdermal patch, ointment, or oral route Manage headache with acetaminophen Instruct men not to take with ED drugs
44
What is the mechanism of action for Statins (atorvastatin, simvastatin)?
Decrease the rate of cholesterol production in the liver by inhibiting hydroxymethylglutaryl coenzyme A reductase (HMG-CoA reductase). May also decrease inflammation as well.
45
What is the drug effect for Statins (atorvastatin, simvastatin)?
Decrease LDL cholesterol by 25-63%
46
What are the adverse effects for Statins (atorvastatin, simvastatin)?
``` Hepatotoxicity Jaundice Anorexia, nausea, vomiting Dark urine, clay colored stool Elevated LFTs ```
47
What are the contraindications for Statins (atorvastatin, simvastatin)?
Prego X category | Grapefruit juice
48
What are the nursing implications for Statins (atorvastatin, simvastatin)?
Initial effects 2 weeks, maximal effects 4 to 6 weeks, reversal of effects upon withdrawal Monitor LFT and CK levels Assess complaints of weakness and muscle aches
49
What is the pt edu for Statins (atorvastatin, simvastatin)?
Most effective when taken at bedtime Immediately report muscle pain/ weakness or indications of liver dysfunction Keep all follow up appointments Avoid alcohol
50
What are the indications of antiplatelets?
Stroke prevention
51
What are the contraindications for antiplatelets?
``` Flu like symptoms in children (Reye's syndrome) Thrombocytopenia Active bleeding GI ulcer Vit K deficiency Recent stroke ```
52
What are the adverse effects of antiplatelets?
Drowsiness, dizziness, confusion, flushing, nausea, vomiting, GI bleeding, thrombocytopenia, bleeding problems
53
What are the nursing implications for loop diuretics?
Monitor fluid volume Monitor blood pressure Monitor electrolytes, especially potassium
54
What should you educate the patient about loop diuretics?
Monitor weight and blood pressure Change positions slowly Eat potassium rich foods (bananas, potatoes, dried fruit, spinach) Take early in the day
55
What are some examples of loop diuretics?
Furosemide, Lasix
56
What is the mechanism of action of thiazide diuretics?
Blocks reabsorption of sodium (Na) and chloride (Cl) in the early distal convoluted tubule which prevents reabsorption of water
57
What are the drug effects of thiazide diuretics?
Diuresis, less than loop diuretic
58
What are the indications for thiazide diuretics?
First line treatment for hypertension
59
What are the contraindications for thiazide diuretics?
Renal insufficiency
60
What are the adverse effects of thiazide diuretics?
``` Dehydration Hypotension Hypokalemia Hyperglycemia Hyperuricemia ```
61
What are the nursing implications for thiazide diuretics?
Monitor fluid volume status Monitor blood pressure Monitor electrolytes, especially potassium
62
What should you educate the patient about thiazide diuretics?
Monitor weight and blood pressure Change positions slowly Eat potassium rich foods Take early in day to avoid nocturia
63
What are the drug effects of niacin?
Decreases triglycerides Decreases LDL Raises HDL cholesterol
64
What are the adverse effects of niacin?
Intense facial flushing and pruritus GI distress Hepatotoxicity
65
What are the nursing implications and things to educate the patient about niacin?
Instruct patient to take 325 mg of aspirin 30 minutes prior niacin to decrease flushing Patient can also take an extended release niacin to prevent asian flush
66
What is the mechanism of action of nitrates?
Dilates veins to reduce venous return and workload of heart | Dilates coronary arteries to improve blood flow
67
What are the drug effects of nitrates?
Decreased cardiac oxygen demand Increased cardiac oxygen supply Treatment of acute angina attacks Prevents angina episodes
68
What are the indications for nitrates?
Stable, unstable, and variant angina
69
What are the adverse effects of nitrates?
Headache Orthostatic hypotension Reflex tachycardia Tolerance
70
What are the contraindications for nitrates?
Hypotension | Erectile dysfunction drugs
71
How should a patient use nitrates during an acute angina attack?
Sublingual administration - burning sensation under tongue Advise patient to sit down and take 1 tablet Relief should occur within 5 mins If no relief, call 911 and take another dose May be repeated every 5 mins for 3 doses Avoid eating, drinking, or smoking until tablet is dissolved
72
How should a nitroglycerin patches be used?
Can be used up to 14 hours Move patch to different place on body to prevent skin irritation Remove patch for 10 - 12 hours each night to reduce risk of tolerance
73
What are the nursing implications for nitrates?
Critical education must be provided to patient regarding each dosage form Identify risk factors for CAD Obtain baseline data regarding frequency, intensity, duration, location, and precipitating factors of attacks Assess vital signs and EKG
74
What is the mechanism of action for Plavix?
Inhibits the activation of the glycoprotein receptors on the surface of the platelet, which alters platelet membrane so that it can no longer receive the signal to aggregate and form a clot.
75
What are the indications for Plavix?
Reduce risk for thrombotic stroke | Post-MI prevention of thrombosis
76
What are the adverse effects of Plavix?
Chest pain, edema Flu like symptoms Abdominal pain, diarrhea, nausea Epistaxis, rash, pruritus
77
What are the nursing implications for Plavix?
Oral use only | Black box warning- genetic abnormalities may have a higher rate of cardiovascular events
78
What is the mechanism of action for Anticoagulants (warfarin, heparin)?
The overall effect is that turns off the coagulation pathway and prevents clots from forming. It cannot lyse a clot.
79
What are the indications for Anticoagulants (warfarin, heparin)?
Prevention of thrombus
80
What are the contraindications for Anticoagulants (warfarin, heparin)?
Severe uncontrolled hypertension Hemorrhagic stroke Bleeding disorders GI bleeding/ ulcers
81
What are the adverse effects for Anticoagulants (warfarin, heparin)?
Bleeding- increase risk when taking aspirin | Heparin- induced thrombocytopenia
82
What is the treatment for an overdose for Anticoagulants (warfarin, heparin)?
Warfarin- Vitamin K | Heparin- protamine sulfate
83
What are the interactions for Anticoagulants (warfarin, heparin)?
Enzyme inhibition of metabolism Displacement of the drug from inactive protein-binding sites Alteration in the platelet count or activity
84
What are the nursing implications for Anticoagulants (warfarin, heparin)?
Double check medication Two RN must verify med is administered correctly Lab values must be drawn daily Warfarin is started while on Heparin to allow therapeutic levels to rise
85
What are the pt edu for Anticoagulants (warfarin, heparin)?
Importance of regular lab testing signs of abnormal bleeding wearing a medical alert bracelet consult MD before taking other meds

Pharm (6 decks)

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