Cardiovascular Flashcards
Describe the primary actions of the following groups of drugs on the cardiac system: Cardiac glycosides (Digoxin), Nitrates, ACE inhibitors, and statins.
glycosides moa[DIGOXIN] + indication and nursing reasp and EDUCATION
Inhibits the Na+/ K+ pump
This increases intracellular Na+ and Ca2+ resulting in increased force of cardiac conduction
Slows conduction velocity from Sa node to AV node resulting in decreased HR
effect is increased SV and CO
indication: heart failure and cardiac arrhythmia most common is atrial fibrillation
Nursing resp - check apical impulse prior to admin due to glycosides having positive inotropic action - WH if less than 60
monitor k+ levels
elderly at risk rt dec liver and renal functon
education - S+S of toxicity [GI]
Describe the primary actions of the following groups of drugs on the cardiac system: Cardiac glycosides (Digoxin), Nitrates, ACE inhibitors, and statins.
nitrates + nursing resp
nitrates
N - aNgina, gtN,
indicated for use in preventing and treating angina
Short acting = glyceryl trinitrate (GTN)
Longer acting = isosorbide dinitrate & isosorbide mononitrate
MOA
Binds to nitrate receptors in vascular smooth muscle resulting in relaxation
End result is ↑ coronary perfusion and↑ O2 delivery to myocardium
Nursing resp - angina action plan - 1]angina symptoms, rest, 1 puff gtn spray. 2] still chest pain 1 more gtn spray 3]still symptoms call 111, chew aspirin if advised
Describe the primary actions of the following groups of drugs on the cardiac system: Cardiac glycosides (Digoxin), Nitrates, ACE inhibitors, and statins.
HMG-CoA reductase inhibitors / statins + nursing resp
MOA
Inhibit the synthesis of cholesterol in the liver by inhibiting the HMG-CoA reductase enzyme. Reduction in cholesterol synthesis results in lower LDL levels – less required to transport cholesterol as there is less cholesterol
Indic - CVD, diabetes
nurse resp - take @ night for max effect, avoid grapefruit, GI upsety, headache and sleep disturbances, eat with a meal
Describe the primary actions of the following groups of drugs on the cardiac system: Cardiac glycosides (Digoxin), Nitrates, ACE inhibitors, and statins.
ace inhibitors + nursing resp, indic
Common drugs – all have the suffix “pril”
Enalapril, cilazapril, lisinopril, perindopril, quinapril
Indications for use
Hypertension, heart failure, lefty ventricular dysfunction following MI, diabetic nephropathy
MOA
ACE inhibitors block the enzyme required for converting angiotensin I to angiotensin II resulting in
decreased vascular tone = ↓ BP
↑ excretion of Na+ and water which ↓ blood volume & ↓ BP
Indic: manage BP by lowering it, HF
nursing resp - caution w diuretics, avoid w renal impair, common for PERSISTENT dry cough, monitor BP and pulse - check for hypotension<90. Monitor K+ level
Describe the primary actions of the following groups of drugs on the cardiac system: Cardiac glycosides (Digoxin), Nitrates, ACE inhibitors, and statins.
anti plat + nursing resp
Indications
Used for the prevention of arterial thrombosis
Common drugs in NZ
Different formulations and available over the counter
Aspirin, aspro, disprin, solprin, aspec, cartia
MOA
Aspirin – inhibits the cyclooxygenase enzyme (COX 1) causing a decrease in synthesis of thromboxane A2 which then inhibits platelet aggregation and vasoconstriction. Aspirin binds to the platelet for the life of the platelet
Nursing resp
Ax Hb and platelet levels
Ax for bleeding, tarry coffee stools [GI bleeding]
Explain the basis of the antihypertensive, antianginal and antiarrhythmic effect of ß-adrenoreceptor antagonists
Binds to β receptors in the autonomic nervous system and prevents the catecholamines (adrenaline / noradrenaline) from stimulating the receptors and resultant sympathetic response.
ANTIHTN Beta blockers work by blocking the effects of the hormone epinephrine, also known as adrenaline. Beta blockers cause the heart to beat more slowly and with less force, which lowers blood pressure.
ANTIANGINAL inhibit the binding of endogenous catecholamines to beta1-adrenoceptors in the heart.
ANTIARRYTHMIC - by blocking the action of the sympathetic nervous system on the heart, they depress SA and AV node function
Explain the mechanisms of action of the following anticoagulants -Heparin and Warfarin and discuss nursing responsibilities when administering the above medications.
WARFARIN plus nursing resp
Explain the mechanisms of action of the following anticoagulants -Heparin and Warfarin and discuss nursing responsibilities when administering the above medications.
Warfarin MOA
Inhibits the synthesis of Vit K dependent clotting factors
Nursing responsibilities - Contra - hx of haemorrhagic conditions. Regular INR tests and drug adjustments depending on INR (time for blood to clot). Risk of bleeding, check for GI bleeding. caution w dental tx
Explain the mechanisms of action of the following anticoagulants -Heparin and Warfarin and discuss nursing responsibilities when administering the above medications.
HEPARIN plus nursing resp
MOA
Heparin – inactivates 2 factors resulting in inhibition of thrombin and preventing fibrin clot formation.
LMWH Low Molecular Weight Heparin - inhibits factor Xa only – resulting in inhibition of thrombin and preventing fibrin clot formation
Nursing respons - lipohypertrophy, not for pregnancy, requires regular aPPT monitoring, monitor for signs of GI bleeding. caution w dental tx
Explain the mechanisms of action of the following antiplatelet drugs - Aspirin, Clopidogrel and Ticagrelor.
Explain the mechanisms of action of the following antiplatelet drugs - Aspirin, Clopidogrel and Ticagrelor.
Aspirin- inhibits platelet aggregation by inhibiting thromboxane A2 (Chewing ensures quicker absorption, this is only in the acute phase) and Ticagrelor by blocking ADP.
Clopidogrel inhibits platelet aggregation via the second chemical ADP
Very briefly explain the mechanism by which thrombolytic drugs dissolve blood clots.
Thrombolytic drugs dissolve blood clots by activating plasminogen, which forms a product called plasmin
Thrombolytic drugs are only administered in inpatient settings under close monitoring as they carry a high risk of serious bleeding
Briefly explain the indications for prescribing/ administering diuretic medications. List the classes of diuretics and briefly explain how the classes differ in their MOA. + adr’s
MOA - diminishing sodium reabsorption at different sites in the nephron, thereby increasing urinary sodium and water losses.
Indications for use include:
heart failure, hypertension – to reduce fluid and therefore reduce cardiac workload
Loop – e.g. frusemide
Potassium-sparing – e.g. Spironolactone
Thiazides – e.g. Bendrofluazide
Common ADR’s
Dehydration & electrolyte imbalance, dizziness, postural hypotension
A drug that increases the force of myocardial contraction is called a
A positive inotropic agent increases the force of myocardial contraction.
Adverse effects of indirect acting vasodilators (e.g. clonidine and methyldopa) include:
Postural hypotension is an adverse effect frequently associated with drugs that are vasodilators.
The action of the beta 1 receptor
The action of the beta 1 receptor increases heart rate and increases heart contractility.
the following electrolyte imbalances increases the risk of digoxin toxicity:
hypokalaemia
