cardiac pharm - E3 Flashcards
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
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
statins
“statin”
-reduces the amount of cholesterol made by the liver and then the liver makes more LDL receptors
-myopathy, rhabdo & hepatotoxicity
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
what class is nitroglycerin
Organic nitrates
Organic nitrates MOA
Dilates veins (both large & small vessels but primarily in the venous system) & decreases preload
nitroglycerin indications
angina
nitroglycerin SE
(related to vasodilation) HA, hypotension & dizziness, reflex tachycardia
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
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)
what drugs can be used to treat stable angina
beta blockers, CCB, Statins, aspirin, nitrates and ranolazine
nitrostat
route: sublingual
type: rapid acting
comments: put underneath tongue, repeat q5 min x as needed
use: active angina
transderm-nitro
route: skin patch
type: short acting
comments: apply to chest or thigh area daily
use: active angina
nitro bid
route: ointment
type: short acting
comments: apply 1-2in to chest or thigh area
use: active angina
lsosorbide
route: sublingual or oral
type: long acting
comments: tolerance builds up over time
use: for prevention of angina attacks
what class is ranolazine
anti anginals
anti anginals MOA
unknown
ranolazine indication
angina
ranolazine SE
HA
Dizziness
Nausea
Constipation
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
ARBs
“satan”
-Block the action of angiotensin 2 after it is formed causing vasodilation
-cannot give to pregnant women pt is required to use contraception
warfarin
anti coag
what class are Sacubitril / valsartan
angiotensin receptor neprilysin inhibitor (ARNI) – RAAS inhibitors
ARNI – RAAS inhibitors MOA
Decreases preload & after load, suppresses aldosterone, and favorably impact cardiac remodeling
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
