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BNPH700 > Cardiac Medications > Flashcards

Cardiac Medications Flashcards

1
Q

How many drug categories are there within the cardiac medications? Give at least one example of a medication for each category

A

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

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2
Q

What is the indication of use for Cardiac Glycosides (Digoxin)?

A

Heart failure and cardiac arrhythmia most common is atrial fibrillation

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3
Q

What is the MOA for Cardiac Glycosides (Digoxin)?

A

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).

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4
Q

What are some adverse drug reactions associated with the use of Cardiac Glycosides (Digoxin)?

A

Anorexia, GI disturbances (Nausea & Vomiting, diarrhoea), confusion, fatigue, visual disturbances

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5
Q

What are some signs and symptoms of digoxin toxicity?

A

Decreased appetite, N & V, abdo pain, diarrhoea, tiredness, bradycardia, visual disturbance, drowsiness, confusion

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6
Q

What is the antidote for digoxin toxicity?

A

Digibind - binds to digoxin and prevents the digoxin from binding to the site of action

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7
Q

What can increase the chance of digoxin toxicity and why?

A

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

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8
Q

What are some monitoring requirements of cardiac glycosides?

A

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).

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9
Q

What patient education would you provide for cardiac glycosides?

A

-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.

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10
Q

What is an example of a Nitrate medication?

A

Glyceryl trinitrate (GTN)

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11
Q

What is the indication of use for nitrates?

A

Nitrates are a direct-acting vasodilator and are commonly indicated for use in preventing and treating angina

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12
Q

What is the MOA for Nitrates (GTN)?

A

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

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13
Q

What are some adverse drug reactions associated with Nitrates?

A

Postural hypotension
Dizziness
Fainting
Headache
Nausea / vomiting
Agitation
Dry Mouth
Blurred vision
Facial flushing
Reflex tachycardia

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14
Q

What patient education would you provide to the patient regarding nitrates?

A

-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

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15
Q

What are some key points from the angina action plan?

A

-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.

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16
Q

What is the suffix for ACE Inhibitors?

A

“Pril”

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17
Q

What are some examples of ACE Inhibitors?

A

Captopril, Enalapril, Cilazapril, Quinapril, Benazepril

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18
Q

What is the indication of use for an ACE Inhibitor like Enalapril?

A

HTN, Heart Failure, post MI, diabetic nephropathy, left ventricular dysfunction

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19
Q

What is the MOA for an ACE inhibitor?

A

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.

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20
Q

What are some adverse drug reactions associated with ACE Inhibitors?

A

Hypotension
Headaches
Dizziness
Fatigue
Nausea
Hyperkalaemia
Renal impairment
Cough: Common to experience dry persistent cough

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21
Q

What drugs can ACE Inhibitors interact with?

A

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.

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22
Q

What are some contraindications associated with ACE Inhibitors?

A

In patients with renal impairment, pregnant woman and patients with known hypersensitivity.

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23
Q

What are some monitoring requirements associated with ACE Inhibitors?

A

Baseline vitals, monitoring of electrolytes and renal function

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24
Q

What patient education would you provide to someone on ACE Inhibitors?

A

-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.

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25
Q

What is the suffix for beta blockers?

A

“olol”

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26
Q

What category does Metoprolol and Propranolol come under for beta blockers?

A

o Beta-1 selective blocker—Metoprolol
o Non-selective beta blocker—Propranolol

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27
Q

What is the indicator of use for beta blockers?

A

Angina
Arrhythmias
Hypertension
Heart failure
Post MI

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28
Q

Where do Metoprolol (selective blocker) target within the body?

A

Beta 1 receptors in the heart (cardio selective)

29
Q

Where do Propranolol (Non-selective blocker) target within the body?

A

Beta 1 (heart) and beta 2 receptors (lungs)

30
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.

31
Q

What are some adverse drug reactions associated with beta blockers?

A

Most common include: Bradycardia
dizziness
hypotension
arrythmias
bronchoconstriction
fatigue
insomnia
depression
nightmares

32
Q

What are some contraindications associated with beta blockers?

A

-Not used in heart block
-Cautions with respiratory conditions as can cause bronchoconstriction
-Cautions with diabetes as can mask a hypo event and inhibit the sympathetic response to a hypo event

33
Q

What patient education would you provide for someone who are on Beta Blockers?

A

-Explain why the person is taking it
- Falls preventions/postural hypotension
- May need to “start low and go slow”
- Monitior BP and pulse
- Monitor for respiratory symptoms
- Report any symptoms to prescriber

34
Q

What is an example of a Diuretic?

A

Frusemide, spironolactone, Bendrofluazide

35
Q

What is the indication of use for a Diuretic?

A

heart failure, hypertension – to reduce fluid and therefore reduce cardiac workload

36
Q

What is the MOA for diuretics?

A

to decrease sodium reabsorption and therefore decreased fluid reabsorption; this directly causes decreased levels of circulating sodium

37
Q

What are some adverse drug reactions associated with diuretics?

A

Dehydration & electrolyte imbalance, dizziness, postural hypotension

38
Q

What is an example of a HMG-CoA reductase inhibitors?

A

Simvastatin, atorvastatin, pravastatin, rosuvastatin

39
Q

What is the suffix for HMG-CoA Reductase Inhibitors?

A

“statins”

40
Q

What is the indication of use for HMG-CoA reductase inhibitors (Simvastatin)?

A

Risk of cardiovascular disease (assessed using the recommended tools)
Prevention of atherosclerosis with hyperlipidaemia / dyslipidaemia

41
Q

What is the MOA for HMG-CoA reductase inhibitors (Simvastatin)?

A

Inhibit the synthesis of cholesterol in the liver by inhibiting the HMG-CoA reductase enzyme. Reduction in cholesterol synthesis results in lower LDL levels – less required to transport cholesterol as there is less cholesterol

42
Q

What are some adverse drug reactions as well as patient education associated with HMG-CoA reductase inhibitors (Simvastatin)?

A

Must report any muscle pain or weakness due to rare but serious risk of myopathy / rhabdomyolysis
GI upset including stomach cramps
Headache & sleep disturbances

education:
ADRS
Dietary advice - reduce cholesterol, alcohol
Discuss smoking cessation
Take at night for maximum effect but watch for insomnia

43
Q

What are some cautions/contraindications of HMG-CoA reductase inhibitors (Simvastatin)?

A

Avoid grapefruit, st John’s Wort and any other drug that may inhibit the metabolism of the statin = increased risk of myopathy/rhabdomyolysis

44
Q

What is an example of an Antiplatelet?

A

Aspirin, aspro, disprin, solprin, aspec, cartia

44
Q

What is the indication of use for an antiplatelet?

A

Used for the prevention of arterial thrombosis

44
Q

What is the MOA for antiplatelet medications?

A

Aspirin – inhibits the cyclooxygenase enzyme (COX 1) causing a decrease in synthesis of thromboxane A2 which then inhibits platelet aggregation and vasoconstriction. Aspirin binds to the platelet for the life of the platelet

45
Q

What are some adverse drug reactions associated with antiplatelet medications?

A

Bleeding, bruising
GI bleeding, dyspepsia

45
Q

What are some Contraindications/cautions associated with antiplatelet medications?

A

-Should not be used for children due to risk of Reye’s Disease
-Caution in older persons due to decreased hepatic and renal function
-Avoid in persons with haemorrhagic conditions, respiratory conditions, coagulation disorders, recent surgery or trauma

45
Q

What patient education would you provide for someone who is on antiplatelet medications?

A

-Avoid taking additional over the counter NSAID’s without advice
-Caution with surgery and dental treatment
- Monitor for signs of GI bleeds, dyspnoea/bronchoconstriction

46
Q

What are two examples of anticoagulants?

A

Clopidogrel, ticagrelor

46
Q

What are the indications for Warfarin?

A

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

46
Q

What is the MOA of Warfarin?

A

Inhibits the synthesis of Vit K dependent clotting factors
Antidote = vitamin K

46
Q

What is the pharmacokinetic concerns with Warfarin?

A

Highly protein bound so need to consider albumin levels, hepatic function, renal function

47
Q

What are the ADR’s (adverse drug reactions) for Warfarin?

A

Bleeding
Chest pain
Dyspnoea
Headache
Dizziness
Visual Disturbance
GI upset

48
Q

What are the contraindications for Warfarin?

A

History of haemorrhagic conditions, alcoholism, elderly (except with prosthetic heart valves), pregnancy

49
Q

What are the monitoring requirements for Warfarin?

A

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

50
Q

What is the patient education for Warfarin?

A
  • Risk of bleeding, look for signs of BI bleeding, care with dental treatment
  • Regular monitoring
  • Need to take at same time each day, do not stop taking without consultation, dont double dose if missed a dose
  • Avoid Vit K, rich foods
51
Q

What are the common drugs within the “Heparin and LMWH” category

A

Heparin
Enoxaparin – LMWH (Clexane)

52
Q

What are is the indications for Heparin and LMWH?

A

Heparin – used for prevention of and treatment of venous thromboembolism, formation of clots in IV catheters, dialysis. Has a shorter half life so used in acute situations.

LMWH – used for prevention of venous thrombi post-surgery, longer half-life than heparin so better for prevention than treatment

53
Q

What is the MOA of Heparin and LMWH?

A

Heparin – inactivates factor Xa & factor II (inhibits 2 factors) resulting in inhibition of thrombin and preventing fibrin clot formation.
Faster acting as works on 2 factors but requires monitoring
Highly protein bound
Antidote = protamine

LMWH - inhibits factor Xa only – resulting in inhibition of thrombin and preventing fibrin clot formation

54
Q

What are the ADR’s of Heparin and LMWH?

A

-Bleeding and bruising
- Lipohypertrophy
- Thrombocytopenia is a rare ADR

55
Q

What are the contraindications of Heparin and LMWH?

A

-Haemorrhagic conditions
- Not recommended in pregnancy
- Renal failure = Heparin

56
Q

What are the monitoring requirement for Heparin and LMWH?

A

Heparin requires regular aPPT monitoring

57
Q

What is the patient education for Heparin and LMWH?

A
  • Alternate sites of injection to prevent bruising and lipohypertrophy
  • Avoid over the counter aspirin and NSAID’s
  • Caution with dental treatment
  • Monitor for signs of GI bleeding.
58
Q

What are common drugs of thrombolytics?

A

Alteplase, tenecteplase

59
Q

What is the indications for Thrombolytics?

A

Used for the treatment of thromboembolism (clots) as they dissolve already formed clots

60
Q

What is the MOA for Thrombolytics?

A

Activates plasminogen to form plasmin, a fibrinolytic enzyme that digests or dissolves fibrin clots.

61
Q

What is some key information for Thrombolytics?

A

Only administered in highly monitored situations
Short timeframe in which they can be administered
ADR of bleeding

BNPH700 (9 decks)

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