Cardiac Pharm Flashcards
common ACE inhibitors
- what does ACE stand for
lisinopril
ramipril
angiotensin converting enzymes
indication of ACE inhibitors
HTN
HF
CAD
renal disease
ACE inhibitor effects on VS
decreased BP (SBP > DBP) w/exercise
increase exercise tolerance in those with HF
adverse reactions of ACE inhibitors
dry, hacking cough
angioedema
hypotension
dizziness
clinical considerations for ACE inhibitors
need to monitor BP closely
if cough is chronic, possibly suggest angiotensin 2 receptor blocker
common adrenergic agonists
levophed
common indication for adrenergic agonists
shock - septic, cardiogenic, anaphylactic
heart failure
adrenergic agonists effect on VS
increased BP via increased TPR
increased HR
increased MAP
adverse reactions to adrenergic agonists
peripheral tissue necrosis
extravasation
dysrhythmias
myocardial ischemia
hyperglycemia
clinical considerations for adrenergic agonists
classified as vasopressors
monitor BP closely
monitor peripheral tissue perfusion
short acting –> may need IV
what are the types of ARBs
ACE inhibitors
Angiotensin II receptor block
common ACE Inhibitor ARBs
sacubitril
valsartan
common ANG2 receptor blocker ARBs
losartan
valsartan
indicator of ARB (ACE inhibitor form)
HF with decreased EF
indication of ANG2 receptor blocker ARB
HTN
HF
Renal disease/failure
effect of ARBs on VS
decreased BP
adverse reactions related to ACE ARBs
hypotension
fatigue
hyperkalemia
renal failure
dizziness
cough
adverse reactions related to ANG2 blocker ARBs
dizziness
hyperkalemia
hypotension
dry cough
angioedema
diarrhea
weight loss
clinical considerations related to ACE ARBs
monitor BP, HR and ECG
clinical considerations for ANG2 blocker ARBs
might be preferred if pt cannot tolerate ACE inhibitors side effects
common anticoagulants
apixaban
warfarin
indication of anticoagulants
prevention/treatment of venous thrombus embolism or other blood clots
atrial fibrillation
artificial heart valves
effects of anticoagulants on VS
none
– unless major bleeding event
adverse reaction related to anticoagulants
bleeding risk
spinal/epidural hematoma
clinical considerations for anticoagulant administration
monitor for:
signs of bleeding
- could include dizziness
tachycardia
hypotension
common antiplatelet agents
clopidogrel
tricagrelor
indication for antiplatelet agents
secondary prevention of MI / ischemic stroke
PAD
effect of antiplatelet agents on VS
no change unless major bleeding event
bradyarrhythmia / dyspnea
- specific to brilinta
adverse reaction to antiplatelet agents
bleeding
dyspnea
bradycardia/bradyarrhythmia
clinical considerations for antiplatelet agents
signs of bleeding
- could include dizziness, tachycardia, hypotension
monitor HR / ECG
common anticholinergics
ipratropium
tiotropium
indication for anticholinergics
bronchoconstriction
bronchospasm / asthma
COPD
effect of anticholinergics on VS
increased temperature
increased ECG changes
adverse reactions to anticholinergics
bronchitis
headache
clinical considerations for anticholinergic administration
CNS effects – dizziness/blurred vision
s/s of anticholinergic poisoning = tachycardia, flushing, anhidrosis, hyperthermia, dilated pupils, agitated delirium, and diminished bowl sounds
common beta-2 agonists
albuterol
indication for beta-2 agonists
bronchoconstriction
bronchospasm / asthma
COPD
effect of beta-2 agonists on VS
acute HR increase upon administration
adverse reactions to beta-2 agonists
tremor
nervousness
bronchospasm
tachycardia
clinical considerations for beta-2 agonist administration
immediate hypersensitivity reactions
anaphylaxis
common nitrate/nitrites
nitroglycerin
isosorbide
amyl nitrite
indication for nitrite/nitrates
angina
hypertensive crisis
hypertensive pulmonary edema
heart failure
low CO syndromes
acute MI
effect of nitrite/nitrates on VS
decreased BP via systemic vasodilation
increased HR at rest / with exercise
adverse reactions to nitrates/nitrites
headache
dizziness
orthostatic hypotension
nausea
clinical considerations for nitrate/nitrite administration
monitor BP
special handling/storage
avoid skin contact w/meds
what are the positive ionotropic drugs
beta 1 agonists
cardiac glycosides
indication of beta-1 agonists
shock - cardiogenic, hypovolemic, septic, anaphylactic
heart failure
indication of cardiac glycosides
acute decompensated heart failure
dysrhythmias
common beta-1 agonists
dopamine
common cardiac glycosides
primacor
what is dobutamine?
- class
- indication
positive inotrope
shock
effect of beta-1 agonists on VS
increased BP / SV
vasoconstriction
– all 3 increase CO
+ chronotropic effects, increased HR
effect of cardiac glycosides on VS
increased BP via increased SV
decreased TPR
effect of dobutamine on VS
increased BP due to increased SV and vasoconstriction
- pressor effect
adverse reaction to beta-1 agonists
dysrhythmias
– tachydysrhythmia in those with shock
adverse reaction related to cardiac glycosides
dysrhythmias
- tachycardia, ventricular, supraventricular
hypotension
headache
bronchospasm
adverse effect of dobutamine
headache
anxiety
dyspnea
severe HTN
asthma exacerbation
dysrhythmia
clinical considerations for beta-1 agonist administration
use RPE scale in adjunct with HR response
ECG monitor
clinical considerations associated with cardiac glycoside administration
IV admin
short half-life (2 hrs)
use RPE with HR monitor
monitor ECG
clinical considerations related to dobutamine
closely monitor BP
use RPE and HR to monitor response to exercise
indicator for statins
- effects
hyperlipidemia
decrease cholesterol biosynthesis
- aim to increase HDL and decrease LDLs
common beta blockers
metoprolol
atenolol
carvedilol
beta blocker indications
acute MI
HTN
HF w/ systolic dysfunction
dysrhythmia
migraine prophylaxis
beta blocker effect on VS
decreased BP (SBP > DBP)
decreased RHR
decreased HR with exercise
adverse reaction of beta blockers
bronchospasms
heart block
masks s/s of hypoglycemia
clinical consideration for beta blocker administration
use RPE in addition to HR response to exercise
increased risk of developing / worsening heart block
auscultate for bronchospasms
types of diuretics
- common versions
loop and thiazide
furosemide
hydrochlorothiazide
indications of diuretics
renal disorders
HTN
decreased edema due to:
- HF
- cirrhosis
- meniere’s
effect of diuretics on VS
decreased BP
SBP > DBP
adverse reactions related to diuretics
hypotension (exacerbated by change of position)
dehydration
ventricular dysrhythmia (K+ imbalances)
hyperglycemia in those with DM
hyperuricemia / gout flare up
