Cardiac Drugs

Question 1

Diltiazem

Answer 1

• class: calcium channel blocker
• mechanism of action: inhibit transport of calcium into myocardial smooth muscle cells = vasodilation to decrease BP, decrease angina, also decrease HR
• nursing assessments: monitor BP, HR, assess for HF, avoid grapefruit juice

Question 2

Enalapril

Answer 2

• class: ACEI, antihypertensive
• mechanism: blocks conversion of angiotensin 1 to angiotensin 2 to decrease aldosterone and prevent reabsorption of sodium and water = decrease BP
• nursing assessments: monitor BP, pulse, assess for HF, assess for cough (SE)

Question 3

Furosemide

Answer 3

• class: diuretic
• mechanism: inhibit sodium reabsorption in nephron, increase excretion of water, sodium, potassium
• nursing assessments: monitor BP and HR, assess fluid status, monitor electrolytes (hypokalemia?)

Question 4

Propranolol

Answer 4

• class: beta blocker
• mechanism: blocks stimulation of beta-adrenergic receptors to decrease HR and BP
• nursing assessments: monitor BP and HR (hold if under 50 bpm), don’t stop abruptly, assess for fluid overload

Question 5

Warfarin

Answer 5

• class: anticoagulant
• mechanism: interferes with vitamin K dependent clotting factors
• nursing assessments: assess for bleeding, monitor INR (should be 2-3 times higher)
• antidote is vitamin K
• takes 3-5 days to reach therapeutic levels
• 1/2 life is 1-3 days
• used for atrial fibrillation

Question 6

Nitroglycerin

Answer 6

• class: nitrates
• mechanism: dliates blood vessels, especially coronary arteries and veins
• SE: reflex tachycardia, orthostatic hypotension
• assess: HR, BP, pain, signs and symptoms of decreased CO

Question 7

Morphine

Answer 7

• class: opioid analgesic
• mechanism: binds to opiate receptors in CNS, this decreases SNS activity causing vasodilation, especially in veins (decreasing preload)
• can decrease BP

Question 8

Fibrinolytics

Answer 8

• for STEMI if within 12 hours and PCI not available in first 90 minutes of contact
• dissolves fresh clots in body
• do not use if bleeding, surgery…

Question 9

Heparin

Answer 9

• class: anticoagulant, antithrombotic
• mechanism: increase the effect of antithrombin to lengthen clotting time, prevents thrombus formation/growth
• nursing assessments: PTT, platelets, bleeding
• antidote: protamine sulfate
• IV onset is immediate, subcut is 1 hr
• 1/2 life is 1.5 hr (good if patient may need surgery)

Question 10

Low Molecular Weight Heparin

Answer 10

• class: anticoagulant, antithrombotic
• mechanism: increase the effect of antithrombin, increase time to clot and prevent formation/growth of clots
• assess: CBC, platelets, bleeding DO NOT NEED TO MONITOR PTT
• duration is longer than heparin, only have to give once or twice a day

Question 11

Clopidogrel

Answer 11

• class: antiplatelet
• used for people who can’t tolerate ASA
• mechanism: reduces platelet aggregation to decrease clot formation/growth
• use for recent MI, stroke

Question 12

Atorvastatin

Answer 12

• class: lipid-lowering agent, antihyperlipidemic
• mechanism: inhibit enzyme involved in cholesterol synthesis
• nursing assessment: lipid levels, monitor liver function and muscle weakeness (SE)

Question 13

Digoxin

Answer 13

• class: antiarrhythmic, positive inotrope (cardiac glycoside)
• mechanism: increases myocardial contractility to increase cardiac output
• monitor apical pulse for 1 minute, should be above 60 bpm, monitor for toxicity

Question 14

Amiodarone

Answer 14

• class: antiarrhythmic
• mechanism: prolongs action potential, increases myocardial contractility
• can decrease HR, watch for toxicity

Question 15

Metformin

Answer 15

• class: antidiabetic, biguanide
• mechanism: decreases liver production of glucose, decreases GI absorption of glucose, increase sensitivity to insulin
• monitor for hypoglycemic reaction: confusion, sweating, increased HR, tremors

Question 16

Glyburide

Answer 16

• class: antidiabetic, sulfonylureas
• mechanism: stimulates release of insulin, increases insulin sensitivity
• monitor for hypoglycemia: confusion, sweating, increased HR, tremors