Cardiac Medications Flashcards
How many drug categories are there within the cardiac medications? Give at least one example of a medication for each category
Cardiac Glycosides - Digoxin
Nitrates - GTN
ACE inhibitors - Enalapril
Diuretics - Furosemide
Beta Blockers – Metoprolol, Propranolol
HMG-CoA reductase inhibitors – Simvastatin
Anti-platelet – Aspirin
Anticoagulants – Warfarin, Heparin
What is the indication of use for Cardiac Glycosides (Digoxin)?
Heart failure and cardiac arrhythmia most common is atrial fibrillation
What is the MOA for Cardiac Glycosides (Digoxin)?
Inhibits active transport (pumping) of sodium and potassium across cell membrane. This increase intracellular sodium and produces a secondary increase in intracellular calcium which increases cardiac contraction. It slows the heart rate by decreasing conduction through the SA and AV nodes (anti-arrhythmic effect).
What are some adverse drug reactions associated with the use of Cardiac Glycosides (Digoxin)?
Anorexia, GI disturbances (Nausea & Vomiting, diarrhoea), confusion, fatigue, visual disturbances
What are some signs and symptoms of digoxin toxicity?
Decreased appetite, N & V, abdo pain, diarrhoea, tiredness, bradycardia, visual disturbance, drowsiness, confusion
What is the antidote for digoxin toxicity?
Digibind - binds to digoxin and prevents the digoxin from binding to the site of action
What can increase the chance of digoxin toxicity and why?
Hypokalaemia and hypercalcemia can increase the risk of digoxin toxicity (visual changes) due to more receptors sites being available for digoxin to bind to = enhanced effect of digoxin
What are some monitoring requirements of cardiac glycosides?
Take apical pulse for a full minute (note irregular heartbeats), Monitor potassium levels in patients taking diuretics or corticosteroids. (Digoxin and potassium compete for the same receptor site).
What patient education would you provide for cardiac glycosides?
-Take with water
-caution using in conjunction with antacids and calcium preparations (should be taken 2 hours apart)
-Teach patient to take pulse and to contact Dr before taking medication -if pulse rate is <60 or >100. Hold medication if HR is below 60bpm
-Review signs and symptoms of digoxin toxicity with patient and family.
-Instruct patient to notify health care professional of all prescription or Over the counter medications.
What is an example of a Nitrate medication?
Glyceryl trinitrate (GTN)
What is the indication of use for nitrates?
Nitrates are a direct-acting vasodilator and are commonly indicated for use in preventing and treating angina
What is the MOA for Nitrates (GTN)?
Bind to nitrate receptors in vascular smooth muscle causing vasodilation in peripheral veins leading to decreased venous return to the heart. This results in decreased O2 demand by myocardium. Also, vasodilation in arteries which lower BP. End result is increased coronary perfusion and increased O2 delivery to the myocardium. More blood flowing through which = more oxygen to the myocardium
What are some adverse drug reactions associated with Nitrates?
Postural hypotension
Dizziness
Fainting
Headache
Nausea / vomiting
Agitation
Dry Mouth
Blurred vision
Facial flushing
Reflex tachycardia
What patient education would you provide to the patient regarding nitrates?
-Be aware of nitrate tolerance – to prevent this, ensure a nitrate free period each day as body can create resistance.
-Have an angina action plan
-Sensitive to light, heat. Store in dark place.
-Discard after 3 months to ensure medication maintains maximum potency
-Sit down on first administration as may cause dizziness
-1 spray under tongue, no more than -3 doses for sublingual
What are some key points from the angina action plan?
-Advise patient to carry meds at all time (away from body heat)
-Sit down and use med at first sign of attack.
-Spray under the tongue (do not inhale), mouth should be closed immediately; do not eat, drink or smoke after delivery of drug.
-Dose can be repeated if pain is not relieved in 5 mins. Call 111 if 3 doses taken 5 mins apart don’t relieve angina pain (not taken more than 3 doses)
-Inform Patient transient headache & flushing may occur. Caution patient to change positions slowly to ↓ postural hypotension.
What is the suffix for ACE Inhibitors?
“Pril”
What are some examples of ACE Inhibitors?
Captopril, Enalapril, Cilazapril, Quinapril, Benazepril
What is the indication of use for an ACE Inhibitor like Enalapril?
HTN, Heart Failure, post MI, diabetic nephropathy, left ventricular dysfunction
What is the MOA for an ACE inhibitor?
inhibits the conversion of angiotensin I to angiotensin II. Leads to decreased BP. Inhibits the release of aldosterone from adrenal cortex. Decreased Na+ and water retention.
What are some adverse drug reactions associated with ACE Inhibitors?
Hypotension
Headaches
Dizziness
Fatigue
Nausea
Hyperkalaemia
Renal impairment
Cough: Common to experience dry persistent cough
What drugs can ACE Inhibitors interact with?
Avoid concurrent use with combination loop diuretics as may result in renal dysfunction. NSAID increases the risk of increased potassium levels and can reduce the effects of the ACE inhibitor.
What are some contraindications associated with ACE Inhibitors?
In patients with renal impairment, pregnant woman and patients with known hypersensitivity.
What are some monitoring requirements associated with ACE Inhibitors?
Baseline vitals, monitoring of electrolytes and renal function
What patient education would you provide to someone on ACE Inhibitors?
-Take meds as prescribed; do not stop ACE inhibitor without consultation with Dr.
-Take medication with food
notify health care professional of all prescription or Over The Counter medications.
-Avoid salt substitutes containing potassium or foods containing high levels of potassium or sodium (Salt raises BP and can lead to faster risk of renal failure and HF)
-Inform patients ADRs. E.g. dizziness, hypotension.
