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NUR 326 > Cardio Pharm > Flashcards

Cardio Pharm Flashcards

1
Q

stable angina goals of pharm

A

relieve chest pain
reduce HLP
improve morbidity and mortality

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2
Q

what drugs are used for stable angina to address relieving chest pain

A

nitrates
beta blockers
CCB
ranolazine

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3
Q

what drugs are used for stable angina to address reducing lipids

A

lipid lowering drugs
aspirin or clopidogrel

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4
Q

what drugs are used for stable angina to address improve morbidity and mortality

A

ACE inhibitors or ARBs

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5
Q

what is the mechanism of nitrates to treat angina

A

dilates veins which dec preload

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6
Q

what is the mechanism of beta blockers to treat angina

A

dec heart rate and contractility

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7
Q

what is the mechanism of CCB to treat angina

A

dilates arterioles, which dec afterload
dec HR and contractility

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8
Q

what is the mechanism of ranolazine to treat angina

A

helps the myocardium generate energy more efficiently

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9
Q

what is the moa of nitrates

A

dilates veins
dec preload

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10
Q

what are adverse effects of nitrates

A

related to vasodilation: h/a (blood more likely to stay in venous system to not as good of blood), hypotension, reflex tachycardia (response to low BP)
tolerance (teaching point)

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11
Q

what are the forms of rapid acting nitrates

A

nitrostat: put underneath tonuge and repeat q 5 mins and do 3x as needed

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12
Q

what are the forms of short acting nitrates

A

transderm-nitro: apply to chest or thigh area daily
nitrobid: apply 1-2 inches to chest or thigh area

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13
Q

what are the forms of long acting nitrates

A

isosorbide: for prevention of anginal attacks
- tolerance builds up over time

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14
Q

what are the nursing implications for nitrates

A

monitor for headaches
- should subside in about 20 mins
apply nitro patches in the morning and remove in the evening
- hairless sites, rotate sites
pt education of treatment and acute chest pain
- monitor for tolerance, SL so dont swallow, fall precautions, no relief in 5 mins then call 911
IV form
- glass bottle with special tubing, monitor for h/a and tachycardia
long acting forms
- taper when d/c to prevent inc chest pain from vasospasms

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15
Q

what class is ranolazine

A

anti anginals

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16
Q

what is the moa of ranolazine

A

unknown

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17
Q

what are warning associated with ranolazine

A
  • prolonged QT interval
  • acute renal failure
  • liver cirrhosis
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18
Q

what are adverse effects of ranolazine

A

headache, dizzy
N, C

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19
Q

what interactions does ranolazine cause

A

CYP450 inhibitor
- NO grapefruit or other CYP450 inhibitor meds

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20
Q

what types of meds are used to treat HF

A

ACEi, ARBs, ARNI *
beta blockers *
mineralocorticoid receptor antagonist *
SLG2 inhibitors *
diuretics
digitalis
nitrates

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21
Q

what is sacubitril

A

HF medications that help dec mortality in pts with dec EF

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22
Q

what is the moa of sacubitril

A

dec preload and afterload
suppresses aldosterone
favorably impact cardiac remodeling

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23
Q

what are the adverse effects of sacubitril

A

hypotension
hyperkalemia
cough (ACEi)

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24
Q

what are nursing considerations for RAAS inhibitors in HF

A

use highest dose possible
ARNIs are thought to be best bc they have the neprilysin inhibitor which helps w the cardiac remodeling
ARBs tolerated best

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25
what are the beta blockers used in HF
carvedilol
26
why is carvedilol typically used for HF
they block both beta and alpha receptors
27
what is carvedilol moa
protects against SNS activation and dysrhythmias reverses cardiac remodeling
28
what are the adverse effects of carvedilol
fluid retention or worsening HF fatigue hypotension !!! bradycardia
29
what is a mineralocorticoid receptor antagonist
sprinolactone
30
what is the moa of sprinolactone
for HF, suppresses Na and water retention which helps offload the LV - associated w dec hospitalizations and cardiac death
31
what are nursing considerations for sprinolactone
monitor K levels because it can cause HYPERkalemia - watch for dysrhythmias monitor for worsening renal failure
32
what class is dapaglifozin
SLG2 inhibitor
33
what is the moa of dapaglifozin
for HF it is not well understood - helps w ventricular offloading through naturiesis/osmotic diuresis w/out actually depleting volume like tradition diuretics - may affect cardiac metabolism/bioenergetics
34
what are the benefits of dapaglifozin
dec readmission, mortality and morbidity
35
what diuretic are HF pts typically on
loop diuretics
36
what are diuretics used to treat
volume overload - symptom relief, no survival benefit
37
how are diuretics given
PO, IV
38
what are the adverse effects of diuretics
hypokalemia hypotension digoxin toxicity
39
what are inotropic drugs
cardiac glycosides --> digitalis sympathomimetics --> dopamine, dobutamine
40
when is digitalis used
typically second line therapy because inc risk of dysrhythmias
41
how are sympathomimetics given
IV drips
42
what do sympathomimetics do?
get the heart to squeeze harder
43
what does a positive inotrophic effect mean
if we can inc contractility of the heart muscle then we can inc the force of contraction ultimately inc cardiac output
44
what is digitalis class
cardiac glycoside
45
what is the moa for digitalis
inhibits Na/K pump causing Ca to collect w/in cells of the heart to inc myocardial contractility - inc blood flow to the kidneys helping with excretion of Na and water - dec sympathetic action and increase parasympathetic action to dec HR
46
what are the adverse effects of digitalis
cardiac dysrhythmias digitalis toxicity
47
who is at risk for digitalis toxicity
older womens combination drugs (digitalis and diuretic therapy)
48
how do we prevent digitalis toxicity
reduce dose serum digitalis levels supplemental K (as long as good kidneys)
49
what are the nursing implications for digitalis
monitor serum K levels: if on digitalis, we dont want their K levels to be low bc can cause - toxicity, cardiac dysfunction, serious dysrhythmias
50
what are the s/s of digitalis toxicity
bradycardia --> hallmark sign headache dizzy confusion N visual disturbances--> blurry, yellow vision
51
what do we teach pts about taking digitalis
take your apical pulse for a full min before taking the medication and hold if below 60 - teach about also being on diuretics and the need to monitor K levels
52
what is the antidote for digitalis
digoxin immune Fab given IV
53
what drugs are used for rate and rhythm control
beta bockers CCB amiodarone adenosine atropine dofetilide
54
what is the ideal of HR and rhythm
less than 100 and normal rhythm
55
what is the moa of amiodarone
prolongs the AP duration and the effective refractory period in all cardiac tissues - blocks alpha and beta adrenergic receptors in the SNS
56
how is amiodarone given
IV, PO
57
what class is amiodarone
anti dysrhythmic
58
what are nursing considerations for amiodarone
one of the most effective anti dysrhythmics used for PVST, ventricular dysrhythmias, afib and RVR 75 % of pt will experience adverse affects contraindicated for ppl w severe bradycardia or heart blocks
59
what are the adverse effects of amiodarone
it is lipophyllic --> fat loving so it will accumulate in ppls fat - thyroid alterations: iodine is in its make up - corneal microdeposits --> light sensitivity, visual halos - can accumulate in pulm causing pulmonary toxicity which is fatal in 10% of cases *black box warning --> pulm and hepatoxicity, pro arhythmic effect
60
what are the interactions of amiodarone
digitialis and warfarin - inc digitoxin - inc INR extremely long half life: can take 2-3 months for symptoms to go away
61
what is atropine used for
sinus brady cardia - experiencing symptoms
62
what class is atropine
anticholinergic antimuscarinic
63
what is the moa for atropine
poisons the vagus nerve inhibits protaglanlionic acetylcholine receptors and direct vagolytic action * only works if bradycardia is vagal induced*
64
how is atropine given
IV push 1 mg q 3-5 mins 3 mg MAX
65
what are the adverse effects of atropine
drying effect xerostomia, blurry vision, photophobia, tachycardia, flushing, hot skin
66
what are the nursing implications for atropine
must be on cardiac monitoring if doesnt work quickly then give second dose
67
what is adenosine used for
PSVT (SVT) and sinus tachycardia
68
what is the moa for adenosine
slows the conduction time through the AV node
69
what are the nursing implications for adenosine
very short half life so may need to give multiple doses only given IV must use a 3 way stop cock
70
how is adenosine given
IVP 6 mg then 12 mg max can give a 3rd 12 mg always follow w rapid normal saline flush or 2 saline flushes
71
what is dofetilide class
antidysrhythmic
72
what are the indications for dofetilide
conversions from afib/atrial flutter to NSR and stay in NSR
73
what is the moa of dofetilide
selectively blocks the rapid cardiac ion channels carrying potassium currents
74
what are the adverse affects fo dofetilide
torsades --> funky rhythm, deadly rhythm that requires CPR *black box warning* SVT headache dizzy chest pain
75
what are the nursing implications of dofetlide
must be started in hospital while pt is on ECG to monitor for torsades dont give to pts with long QT intervals or other drugs that may prolong QT intervals must also be on warfarin bc of risk of stroke w afib

NUR 326 (20 decks)

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