Cardiac / PVD pharm Flashcards
what does cilostazol do?
inhibits platelets and increases vasodilation
what is cilostazol used for?
treatment for intermittent claudication
what are the side effects of cilostazol?
HA, dizziness, diarrhea, abnormal stools, palpitations, peripheral edema
why is it important to mention if you are taking cilostazol?
this medication is metabolized by CYP450 - and may interact with drugs that change CYP450 action
what class is pentoxifylline?
vasoactive agent
what is the MOA of pentoxifylline?
relieves leg pain by increasing blood flow and oxygen through blood vessels
what is pentoxifylline used for?
treatment for intermittent claudication caused by PVD - will help to increase walking distance and duration
what are common side effects of pentoxifylline?
N/V, dizziness
what class is nitroglycerin?
organic nitrate
what is the MOA of nitroglycerin?
dilates veins (both large and small), decreases preload
what are common side effects with nitroglycerin?
HA, hypotension, reflex tachycardia, tolerance to medication (this can happen quickly)
what medications / substances does nitroglycerin react with that may severely decrease blood pressure?
sildenafil, antihypertensive, alochol
what are educational points for patients that are taking nitroglycerin (in general) for stable angina?
only take when you are having chest pain or truly anticipate having it - tolerance builds fast
only take as much as you need at that moment
may make you dizzy / lightheaded
if no relief in the first 5 minutes - call 911, but take another one (up to 3 doses)
what educational points for patients using transderm - nitro?
apply in the morning and remove in the evening
use on hairless spots
rotate sites
nitro-bid is what type of nitro?
ointment
what educational points are important for a patient taking isosorbide long term?
you cannot stop this medication abruptly due to the risk of vasospasms and more chest pain
what class of medication is ranolazine?
anti-anginal
what is the MOA of ranolazine?
really unknown, maybe helps the myocardium use energy more efficiently
what are the side effects with ranolazine?
HA, dizziness, nausea, constipation
what are the warnings associated with ranolazine?
prolonged QT interval
acute renal failure - worsening existing
CYP inhibitor
what juice should a patient avoid while taking ranolazine?
grapefruit juice because it is a CYP inhibitor
what class of medication is sacubitril / valsartan?
angiotensin receptor neprilysin inhibitor
what is the MOA of sacubitril / valsartan?
decreases preload and afterload
suppresses aldosterone
what are the side effects of sacubitril / valsartan?
hypotension
hyperkalemia
what class of medication is digitalis?
cardiac glycoside
what is the MOA of digitalis?
inhibits sodium-potassium ATP pump
causes calcium to collect in the heart cells
helps increase myocardial contractility
increases blood flow to the kidneys
increases excretion of sodium and water
decreases sympathetic action and increases parasympathetic action (aka decreases HR)
what are the side effects of digitalis?
cardiac dysrhythmis, toxicity (bradycardia, HA, dizziness, confusion, nausea, visual disturbances, yellow vision)
who is at risk for digitalis toxicity?
older women, those on diuretic therapy and digoxin
what levels need to be monitored while taking digitalis?
drug levels - not peak and trough though
K+ levels
what is the pulse restriction for digitalis?
hold if < 60
what is the antidote for digitalis?
digoxin immune fab (digibind) IV
what class is dopamine / dobutamine
sympathomimetics
what do dopamine / dobutamine do?
make the heart pump harder
what class of medication is amiodarone?
anti - dysrhythmic
what is the MOA of amiodarone?
prolongs the action potential duration and the refractory period in all cardiac cells
blocks alpha and beta adrenergic receptors in the SNS
what is amiodarone used for?
PSVT, ventricular dysrhythmias, afib
what are the side effects of amiodarone?
thyroid alterations
corneal microdeposits (halos, dry eyes, light sensitivity)
pulmonary toxicity (black box warning)
hepatotoxic
proarrhythmic effect
where can amiodarone become concentrated and why?
adipose tissue because it is very lipophilic
what drugs does amiodarone interact with?
warfarin - increases INR by 50-100%
digoxin - increases levels by 50%
if someone starts taking amiodarone and eventually develops side effects, how long after stopping will the medication finally be out of the system?
2-3 months
what conditions are contraindicated with taking amiodarone?
people with severe bradycardia / heart blocks
what class of medication is atropine?
anti - cholinergic
anti - muscarinic
what is the MOA of atropine?
poisons that vagus nerve
inhibits postganglionic acetylcholine receptors
what is atropine used for?
symptomatic sinus bradycardia
what are the side effects of atropine?
blurry vission
xerostomia
photophobia
tachycardia
flushing
hot skin
how is atropine given?
IV push
how many doses of atropine can you give?
3 max
what is imperative when giving a patient atropine?
they have to be on cardiac monitoring
how does adenosine work?
slows the conduction time through the AV node
what is an expected effect of adenosine?
asystole
can you give multiple doses of adenosine?
yes
what class of medication is dofetilide?
anti - dysrhythmic
what does dofetilide do?
selectively blocks the rapid cardiac ion channel that carries potassium
what is dofetilide used for?
conversion from afib / a-flutter to NSR
what are the side effects of dofetilide?
torsades (vtach - start CPR)
SVT
HA
dizziness
chest pain
what is imperative when giving a patient dofetilide?
they have to be on cardiac monitoring
