cardiac pharm - E3 Flashcards by Jane Daum

beta blockers

“olo”
-take BP every time before giving and hold + contact HCP if HR is less than 60 or systolic BP is less than 100
-vasodilation
-can mask hypogly by preventing tachycardia which is one of the main signs of hypogly

How well did you know this?

Not at all

Perfectly

calcium channel blockers

“dipine”
-decreased contractility & conductivity of the heart as well as lowers the demand for oxygen (vasodi)
-best for AA d/t lack of angioedema seen w/ ACEs

How well did you know this?

Not at all

Perfectly

statins

“statin”
-reduces the amount of cholesterol made by the liver and then the liver makes more LDL receptors
-myopathy, rhabdo & hepatotoxicity

How well did you know this?

Not at all

Perfectly

ACE

“pril”
-Blocks angiotensin converting enzyme (ACE) which inhibits production of angiotensin 2 (a power vasoconstrictor)
-first dose hyponten
-do not give to pregnant women, risk for hyperK+ & neutropenia
COUGH

How well did you know this?

Not at all

Perfectly

what class is nitroglycerin

Organic nitrates

How well did you know this?

Not at all

Perfectly

Organic nitrates MOA

Dilates veins (both large & small vessels but primarily in the venous system) & decreases preload

How well did you know this?

Not at all

Perfectly

nitroglycerin indications

angina

How well did you know this?

Not at all

Perfectly

nitroglycerin SE

(related to vasodilation) HA, hypotension & dizziness, reflex tachycardia

How well did you know this?

Not at all

Perfectly

nitroglycerin nursing considerations

Severe hypotension when taken w/ sindenafil, antihypertensices & alcohol

Can develop tolerance quickly -> only take as many as needed until pain goes away

Fall precautions

Do not exceed 3 doses

Long acting has to be tapered & it is a 1 time dose -> if pain is still present take another form but not another long acting

How well did you know this?

Not at all

Perfectly

if you take Nitroglycerin and in 5 minutes pain doesn’t resolve, what do you do

If taken and no relief in 5 mins, call 911 (can take another one but have to call)

How well did you know this?

Not at all

Perfectly

what drugs can be used to treat stable angina

beta blockers, CCB, Statins, aspirin, nitrates and ranolazine

How well did you know this?

Not at all

Perfectly

nitrostat

route: sublingual
type: rapid acting
comments: put underneath tongue, repeat q5 min x as needed
use: active angina

How well did you know this?

Not at all

Perfectly

transderm-nitro

route: skin patch
type: short acting
comments: apply to chest or thigh area daily
use: active angina

How well did you know this?

Not at all

Perfectly

nitro bid

route: ointment
type: short acting
comments: apply 1-2in to chest or thigh area
use: active angina

How well did you know this?

Not at all

Perfectly

lsosorbide

route: sublingual or oral
type: long acting
comments: tolerance builds up over time
use: for prevention of angina attacks

How well did you know this?

Not at all

Perfectly

what class is ranolazine

anti anginals

How well did you know this?

Not at all

Perfectly

anti anginals MOA

unknown

How well did you know this?

Not at all

Perfectly

ranolazine indication

angina

How well did you know this?

Not at all

Perfectly

ranolazine SE

HA
Dizziness
Nausea
Constipation

How well did you know this?

Not at all

Perfectly

ranolazine nursing consideration

Can prolong QT interval

Caution if pt has acute renal failure or liver cirrhosis

CYP340 inhibitor-> avoid grapefruit and other meds that are inhibitors

How well did you know this?

Not at all

Perfectly

ARBs

“sartan”
-Block the action of angiotensin 2 after it is formed causing vasodilation
-cannot give to pregnant women pt is required to use contraception

How well did you know this?

Not at all

Perfectly

warfarin

anti coag

How well did you know this?

Not at all

Perfectly

what class are Sacubitril / valsartan

angiotensin receptor neprilysin inhibitor (ARNI) – RAAS inhibitors

How well did you know this?

Not at all

Perfectly

ARNI – RAAS inhibitors MOA

Decreases preload & after load, suppresses aldosterone, and favorably impact cardiac remodeling

How well did you know this?

Not at all

Perfectly

Sacubitril / valsartan indications

heart failure

Sacubitril / valsartan SE

Increased potassium levels Hypotension cough

Sacubitril / valsartan nursing considerations

Use highest dose possible

what are the RAAS inhibitors for heart failure

ACE ARBs ARNI **never use all 3 together, have to just pick 1**

what class is carvedilol

beta blocker

beta blocker MOA (for heart failure)

**decreases heart rate, contractility and afterload** Protects against SNS activation and dysrhythmias, reverses cardiac remodeling

Carvedilol indication

heart failure

Carvedilol SE

Fluid retention or worsening HF Fatigue Hypotension Bradycardia

Carvedilol nursing consideration

Hold if systolic is <100 or HR is <60

what class is Dapaglifozin

SLG2 inhibitors

SLG2 inhibitor MOA

Not well understood for HF -> thought to help w/ ventricular unloading through natriuresis / osmotic diuresis w/o actually depleting volume like traditional diuretics & may affect cardiac metabolism/bioenergetis

Dapaglifozin indication

Heart failure Diabetes

Dapaglifozin nursing considerations

Helps decrease readmissions, mortality and morbidity

diuretics in HF

-100% symptom relief w/ no survival benefit -can cause hypoK & hypotension -**risk for digoxin toxicity**

what class is Digitalis

Cardiac glycosides

Cardiac glycosides MOA

Inhibits sodium potassium ATP pump causing calcium to collect within the cells of the heart helping to **increase myocardial contractility** Increases blood flow to the kidney helping with excretion of sodium & water, decreases sympathetic action and increases parasympathetic action which all **decrease HR** **think potassium**

Digitalis indications

heart failure

Digitalis SE

Cardiac dysrhythmias **Digitalis toxicity**

Digitalis nursing considerations

2nd line med d/t risk for dysrhythmias Toxicity occurs with the combo of digoxin and diuretics (which all HF pts are on) -> periodic monitoring of levels take apical pulse for 1 min **Hold med if pulse is <60** monitor cardiac rhythm & serum K+ levels

antidote for digitalis

digoxin immune fab (digibind) given IV

what drugs are for rate and rhythm control

CCB, amiodarone, adenosine, atropine and dofetilide

what class is amiodarone

Antidysrhythmic

amiodarone MOA

Prolongs the action potential duration and the effective refractory period in all cardiac tissues; blocks alpha and beta adrenergic receptors in the SNS

amiodarone indication

PSVT Ventricular dysrhythmias Afib w/ RVR

amiodarone SE

**Lots of effects** pulmonary toxicity (fatal in 10% of pt) Thyroid alterations Corneal microdeposits

amiodarone nursing considerations

Lipophilic so can be concentrated in adipose tissues Caution w/ people with thyroid/iodine problems **BBW: pulmonary toxicity, hepatotoxicity, and pro arhythmic effects** **Interacts w/ digoxin (inc levels by 50%) & warfarin (inc INR by 50-100%)** Extremely long half life, can take 2-3 months to clear **Contraindicated in people with severe bradycardia or heart blocks (a type of rhythm)**

what class is Atropine

Anticholinergic

Atropine MOA

Poisons the vagus nerve; inhibits postganglionic acetylcholine receptors and direct vagolytic action

Atropine indication

**Symptomatic** sinus bradycardia

Atropine SE

Xerostomia Blurry vision Photophobia Tachycardia Flushing Hot skin

Atropine nursing consideration

**Only works if brady is vagal induced** (if sick heart problem then wont help but we usually don’t know the cause so always try) Give it IVP ONLY for bradycardia, **1mg every 3-5 mins, 3mg max** Never give if not on cardiac monitoring

what class is Adenosine

antidysrhythmic

Adenosine MOA

Slows the conduction time through AV node

Adenosine indication

PSVT Sinus tachy

Adenosine SE

very few

Adenosine nursing consideration

Very short half life so may need multiple doses **Causes short burst of asystole until sinus rhythm returns** Only given IV -> 6mg IVP, if have no converted give 12mg IVP, can give a 3rd time 12mg IVP **(always follow w/ rapid normal saline flush or 2 saline flushes)**

what class is Dofetilide

antidysrhythmic

Dofetilide MOA

Selectively blocking the rapid cardiac ion channel carrying potassium currents

Dofetilide indication

Conversion from afib/aflutter to NSR

Dofetilide SE

**Torsades** (a deadly rhythm that needs CPR immediately) SVT Headache Dizziness Chest pain

Dofetilide nursing considerations

**Stay in the hospital w/ ECG monitoring due to risk of torsades (BBW)** don’t give pt w/ long QT intervals or other drugs that may prolong QT intervals

what class is cilostazol

platelet inhibitor

cilostazol MOA

platelet inhibitor and vasodilation

cilostazol SE

headache, dizziness, diarrhea, abnormal stools, palpitations, peripheral edema

cilostazol nursing considerations

metabolized by cytochrome P450

cilostazol indication

peripheral vascular disease

what class is pentoxifylline/trental

vascoactive agent

pentoxifylline/trental MOA

relieves leg pain by increasing blood flow and oxygen through the blood vessels

pentoxifylline/trental SE

N/v, dizziness

what drugs can be used to rate control A.fib

beta blockers, CCB, digitalis, amiodarone +Dofetilide