Cardiac Drugs Flashcards
Drugs used for stable angina relief
Nitrates, beta blockers, Ca channel blockers, Ranolazine
Drugs for stable angina reduction
Lipid lowering, aspirin or clopidrogrel
Drugs for improving stable angina
ACEs or ARBs
Nitroglycerin class, indications, MOA
- nitrates
- angina
- Dilate veins, which dec preload and takes pressure off heart (dilates all vessels, big and small, esp veins)
Nitrates NC
- tolerance can occur quickly - only use with actual angina or know you will have it (prophylactic for exercise)
- if take once and doesn’t help, don’t take another
- can take Tylenol for HA but often doesn’t last long
- risk for hypo/dizzy
- no relief in 5 min - 911 (but also take another, don’t exceed 3)
- IV form - glass bottle and special tubing (severe HA and tachy)
- severe hypotension with sildenafil, antiHTN, alc
Nitrostat
- nitrates
- ACTIVE ANGINA
- sublingual; use every 5 min x3
Nitrates SE
- R/t vasodilation - HA, hypotension/dizzy, reflex tachy (compensate)
Transderm-Nitro
- short-acting nitro
- chest or thigh
- rotate site
- hairless site
- on in morning, off at night
Nitro-bid (2%)
- short acting nitro
- 1-2 inches to chest or thigh area
- cover with piece of paper
Isosorbide
- long acting nitrate
- PREVENTION
- only long acting
- taper to prevent inc pain from coronary artery vasospasm
- not for current pain and can take
- SPECIAL SE: VASOSPASM
Ranolazine class, MOA
Antianginal agent
- Helps myocardium generate energy more efficiently; unknown
Ranolazine SE and NC
- HA, dizzy, nausea, constipation
- only PO
- can PROLONG QT INTERVAL (risk for other lethal dysrhythmia)
- careful with liver/kidney fail
- CYP 340 inhibitor (avoid grapefruit and other inhibitors)
sacubitril/valsartan class, MOA
- Angiotensin receptor-Neprilysin inhibitor (ARNI)
- Dec preload and afterload, suppress aldosterone, which helps with cardiac remodeling
Ppl with HF are often on…
- ACE, ARB, or ARNI
- beta blocker
- mineralcorticoid rec antagonist
- SLGT2 inhibitor
sacubitril/valsartan SE and NC
- Hypotension, hyperkalemia, cough (ACE)
- highest dose possible
- ARNI best bc have Nepriysin inhibit but pricy
- ARBs might be tolerated better
Which drug is a mineral corticoid receptor antagonist and how does it work?
Spironolactone - suppresses Na/H2O retention and offloads the LV
Carvedilol class, MOA
- Beta and alpha blockade
- Protects against SNS activation (neurohormonal) and dysrhythmia, reverse cardiac remodeling
Carvedilol SE and NC
- Lethargy, fatigue, dec BP, bradycardia, can exacerbate lung issues, fluid retention, worsening HF
- wean when discontinuing the med to avoid CVD event, - watch asthma patients,
- no give with HR <60 or SBP<100
Dapagliflozin class, MOA
- SLPG2 inhibitor
- Not well known; helps with vent unloading thru natriuresis/osmotic diuresis w/o actually depleting volume like most diuretics; may affect cardiac metab and bioenergetics (NOT TOO IMPORTANT TO KNOW)
Dapaglifozan NC
- no ESRD or severe kidney
- oral
- dec readmission, mort and morb
Diuretics w/ HF
- LOOP is first line
- vol overload
- oral or IV
- SE - hypokalemia, hypotension, digoxin tox
- no survival benefit, just helps sx
Digitalis class and MOA
- Cardiac glycosides - inotropic drug
- Inhibit Na/K ATP pump in cardiac cell which causes Ca to collect in heart which inc contractility; inc BF to kidneys and dec sympathetic action to dec HR
- Second line bc inc risk dysrhythmias
Digitalis SE and NC
- Cardiac dysrthymias (A fib, A flutter), digitalis tox,
- high risk tox - age, women, combo drugs like diuretics
- monitor levels (weekly INR)
- dec dose
- supplemental K bc inc risk tox with low K (higher risk with diuretics)
- take apical pulse full minute before and hold<60
- antidote for tox is Digibind (only if severe)
What is the other inotropic drug that we see?
Sympathomimetics like dopamine and dobutamine
Amiodarone class, indications, MOA
- Antidysrthmic
- Help bring out a fib and vent dysrhtmia
- Prolong AP duration and effective refractors period in all cardiac tissues; blocks alpha and beta adrenergic rec in SNS
Digitalis tox sx
- brady, HA, dizzy, confusion, Nausea, visual disturbances (blurry, yellow vision)
Amio SE and NC
- Many adverse (75% have)- thyroid alterations corneal microdeposits - light sensitivity, dry eye, visual halo; can cause pulm tox (fatal sometimes)
- IV or PO
- very lipidphyllic - gets conc in adipose tissue
- may not see for pt with iodine allergies
- BLACK BOX - pulm tox, hepatotox, pro-arythmic fx (new rhythm)
- intx with Digoxin (tox) and warfarin (can GREATLY inc INR)
- v long half life - can take 2-3M for SE to leave
- CI with severe brady or heart blocks
Atropine class, indications, and MOA
- Antichol and antimuscarinic
- sinus brady
- Poisons the vagus nerve, inhib postganglionic ACh rec and direct vagolytic action
Atropine SE and NC
- ACh - Xerostomia, blurry vision, photophobia, tachy, flushing, hot skin
- only for symptomatic (don’t use if they talking) and VAGALLY INDUCED brady
- does not work on sick hearts
- IVP (1mg q3-5, 3mg MAX)
- only work ¼ ppl
- NEED ON TELE
Adenosine MOA and indications
- SVT, PSVT, sinus tach
- Slows the conduction of time thru AV node
Adenosine SE and NC
- v short half life (may need multiple doses)
- cause short burst asystole (flat line)
- only IV (6mg IVP, can give another 12mg if not converted, can give 3rd 12 mg if needed)
- always follow with flush (rapid or 2 normal)
- given with stopcoc
- needs AED pads on
Dofetilide (Tikosyn) class, indications, and MOA
- Antidysrhythmic
- A fib, a flutter to stay in sinus rhythm (maintenance)
- Selectively blocking rapid cardiac ion channel carrying K currents
Dofetilide (Tikosyn) SE and NC
- High risk of Torasades (polymorphic V tach - deadly - CPR) and SVT, HA, dizzy, chest pain
- always start in hospital on tele (ECG)
- don’t give for long QT or other drugs that may prolong QT
Why is warfarin given for cardiac probs
Given in conjunction with rhythm problems like a-fib or a-flutter to dec risk of stroke
Cilostazol (pletal) MOA and indication
- IC
- Platelet inhibitor and vasodilation
Cilostazol SE and NC
- HA, dizzy, diarrhea, abnormal stools, palpitations, peripheral edema
- metab by Cyp 450
Pentoxifylline class, MOA, and indications
- Vasoactive agent
- Txs intermittent claudication caused by PVD
- Relieve leg pain by inc BF and oxygen thru BVs, helps to inc walking distance and duration
Pentoxifyllines SE and NC
- N/V, dizzy
- PO TID
