Cardiovascular Flashcards
What are anticoagulants?
Meds that prevent the extension and formation of clots by inhibiting factors in the clotting cascade and decreasing blood coagulability.
Uses of anticoagulants
As in to treat which issues
MI, unstable angina, atrial fibrillation, DVT, pulmonary embolism, when the pt has mechanical heart valves
Contraindications of anticoagulants
With active bleeding, bleeding disorders, blood dyscrasias, ulcers, liver and kidney disease, hemorrhagic brain injuries
Side effects of anticoagulants
Hemorrhage, hematuria, epistaxis, ecchymosis, bleeding gums, thrombocytopenia, hypotension
What is Heparin Sodium?
Anticoagulant that prevents thrombin from converting fibrinogen to fibrin
What is the normal activated partial thromboplastin time (aPTT)?
- How much higher should it be for therapeutic levels?
30-40 seconds
- Should be 1.5-2.5 times the normal value
How often do we measure aPTT during initial Heparin infusion therapy?
Every 4-6 hours
At what points (too high and too low) should we change the dosage of Heparin?
Above 90 seconds: dosage needs to be lowered
Below 60 seconds: dosage needs to be increased
Monitoring for Heparin
Bleeding gums, bruises, nosebleeds, hematuria, hematemesis, occult blood in stool, petechia
What is the antidote for Heparin?
Protamine sulfate
Name the (4) oral anticoagulants
Warfarin sodium, Dabigatran etexilate mesylate, Rivaroxaban, Apixaban
Name the (7) parenteral anticoagulants
Argatroban, Bivalirudin, Dalteparin, esirudin, Enoxaparin, Fondaparinux, Heparin sodium
What is Enoxaparin?
- How is it different from Heparin?
Anticoagulant that prevents thrombin from converting fibrinogen to fibrin
- Differs from heparin as it has a longer half-life
Where does Enoxaparin need to be administered?
Has to be given via subcutaneous injection into either the anterolateral or posterolateral abdominal wall
What is the antidote for Enoxaparin?
Protamine sulfate
What is Warfarin Sodium?
Anticoagulant that suppresses coagulation by acting as an antagonist for vitamin K by inhibiting four dependent clotting factors
Uses of Warfarin
Prevention of thrombophlebitis, pulmonary embolism, and embolism caused by atrial fibrillation, thrombosis, MI or heart valve damage
What is the normal prothrombin time (PT)?
- How much higher should it be for therapeutic levels?
11-12.5 second
- Therpeutic range is 1.5-2 times the normal
What is the normal International normalized ratio (INR)?
- How much higher should it be for therapeutic levels?
- 8-1.2
- Standard therapy is 2-3 times normal
- High dose therapy is 3-4.5 times normal
When should be initiate bleeding precautions?
When the PT is longer than 30 seconds or the the INR is greater than 3.0
What is ‘bridge therapy’?
When heparin is being used at the same time as warfarin until therapeutic INR is reached then the heparin is stopped
What is the antidote for warfarin?
Phytonadione
What is Dabigatran etexilate?
Anticoagulant that works through direct inhibition of thrombin, preventing conversion of fibrinogen to fibrin
Uses of Dabigatran
Clot prevention associated with nonvalvulr atril fibrillation
What is the major benefit of Dabigatran?
There is not blood work needed for serum monitoring
What is Rivaroxaban?
Anticoagulant that works through inhibition of factor Xa
Uses of Rivaroxaban
Clot prevention associated with nonvalvular atrial fibrillation and post-joint major joint replacement
What are thrombolytics?
Meds tht activate plasminogen, which in turn activates plasmin (which dissolves clots)
Name the (2) thrombolytics
Alteplase and Tenecteplase
Uses of thrombolytics
Early treatment of MI (first 4-6 hours), restore blood flow, limit myocardial damage, atrial trhombosis, DVT, occluded shunts or catheters, and pulmonary emboli
Contraindications of thrombolytics
Active internal bleeding, history of hemorrhagic stroke, intracranial trauma, intracranial or intraspinal surgery in last 2 months, surgery in last 10 days, uncontrolled HTN, hepatic or renal disease
Side effects of thrombolytics
Bleeding, dysrhythmias, allergic reactions
Monitoring for thrombolytics
aPTT, PT, fibrinogen level, hematocrit, and platelet count
When a pt is on thrombolytics and a puncture is determined necessary what must we do?
Hold pressure over the site for 20-30 minutes
What is the antidote for thrombolytics?
Aminocaproic acid
What are antiplatelet medications?
Meds that inhibit the aggregation of platelets in the clotting process, thereby prolonging the bleeding time
Name the (8) oral antiplatelet meds
ASA, Anagrelide, Cilostazol, Clopidogrel, Dipyridamole, Ticlipodine, Ticagrelor, Persantine
Name the (3) parenteral antiplatelet meds
Abciximab, Eptifibatide, Tirofiban
Uses of antiplatelet medications
Complications following MI, coronary revascularization, stents and stroke
Contraindications of antiplatelet meds
Bleeding disorders
Side effects of antiplatelet meds
Bruising, hematuria, GI bleeding, tarry stools
What are positive inotropic and cardiotonic medications?
Meds that stimulate myocardial contractility and produce positive inotropic effect
Uses of positive inotropic meds
Short-term management of advaned heart failure; improves cardiac, peripheralm and kidney function; decreases preload, increases cardiac output, decrease edema and increase fluid secretion
What is Dopamine?
Positive inotrope, increases myocardial contractility, dilates renal blood vessels
What is Dobutamine?
Positive inotrope, increases myocardial contractility
What is Milrinone lactate?
Positive inotrope, used for short-term management of heart failure
Side effects of positive inotropes
Dysrhythmias, hypotension, thrombocytopenia, hepatotoxicity,
What cannot be mixed with Inamrinone?
Glucose-containting solutions
What is a cardiac glycoside?
- What is the name of the common cardiac glycoside?
Meds that inhibit the sodium-potassium pump, thus increases intracellular calcium causing the heart muscle fibers to contract more efficiently (inc myocardial contractility), slows heart rate, slows conduction through the AV node
- Digoxin
What does increased contractility do for the body?
Increases cardiac, peripheral and kidney function by increasing cardiac output, decreasing preload, improving blood flow to the periphery and kidneys, decreasing edema and increasing fluid excretion
Uses of cardiac glycosides
Heart failure, cardiogenic shock, atrial tachycardia, atrial fibrillation, atrial flutter, used less frequently for rate control
Side effects of cardiac glycosides
Anorexia, N+V, bradycardia, visual disturbances, headache, fatigue, weakness, drowsiness
What are the earliest signs of digoxin toxicity?
GI manifestations (anorexia, N+V, diarrhea)
What is the therapeutic range for Digoxin?
0.5-0.8 ng/mL
Which conditions increase the likelihood of Digoxin toxicity?
Hypercalcemia, hypokalemia, hypomagnesemia, and hypothyroidism
What serum potassium equals hypokalemia?
Serum potassium below 3.5meq/L (3.5 mmol/L)
What are the 4 classifications of diuretics?
Loop diuretics, osmotic diuretics, potassium-retaining diuretics, thiazide diuretics
What are Thiazide diuretics?
- Uses
Increase sodium and water excretion by inhibiting sodium reabsorption in the distal tubule of the kidney.
- HTN, peripheral edema
Name the (5) Thiazide diuretics
Chlorothiazide, Chlorthalidone, Hydrochlorothiazide, Indapamide, Metolazone
Adverse effects of Thiazide diuretics
Hypercalcemia, hyperglycemia, hyperuricemia, hypokalemia, hyponatremia, hypovolemia, hypotension,
When should Thiazide diuretics be administered?
In the morning with food
What are Loop diuretics?
- How are they different from thiazide diuretic?
Med that inhibits sodium and chloridereabsorption from the loop of Henle and distal tubule.
- More potent, cause rapid diuresis, and thus decrease vascular fluid volume, cardiac output and BP
Uses of Loop diuretics
HTN, pulmonary edema, edema associated with heart failure, hypercalcemia, and renal disease
Side effects of loop diuretics
Hypokalemia, hyponatremia, hypocalcemia, hypomagnesemia, thrombocytopenia, hyperurecemia, orthostatic hypotension, ototoxicity, thiamine deficiency
Name the (4) Loop diuretics
Bumetanide, Ethacrynic acid, Furosemide, Torsemide
How should IV Furosemide be administered?
Slowly over 1-2 minutes. Or it could cause hearing loss.
What are potassium-retaining diuretics?
- Uses
Meds that act on the distal tubule to promote sodium and water excretion and potassium retention.
- Edema, HTN, increase urine output, treat fluid retention, ascites,
Contraindications of potassium-retaining diuretics
Severe kidney or hepatic disease, severe hyperkalemia, diabetes, taking antihypertensive, taking lithium, taking ACE inhibitors, taking potassium supplements
Side effets of potassium-retaining diuretics
Hyperkalemia, N+V, diarrhea, rash, dizziness, headache, dry mouth, anemia, thrombocytopenia
What are the signs and symptoms of hyperkalemia?
Nausea, diarrhea, abdominal cramps, tachycardia and peaked T waves on ECG
What serum level indicates hyperkalemia?
Serum potassium above 5.0 mEq/L (5.0 mmol/L)
Name the (5) potassium-retaining diuretics
Amiloride hydrochloride/hydrochlorothiazide, Eplerenone, Spironolactone, Spironolactone/hydrocholorthiazide, Triamterene
What are Peripherally acting alpha-adrenergic blockers?
Meds tht decrease sympathetic vasoconstriction by reducing the effects of norepinephrine at peripheral nerve endings, resulting in vasodilation and decreased BP.
Name the (3) peripherally acting alpha-adrenergic blockers
Doxazosin, Prazosin, Terazosin
Side effects of peripherally acting alpha-adrenergic blockers
Orthostatis hypotension, reflex tachycardia, edema, sodium and water retention, edema, weight gain, GI disturbances, drowsiness, nasal congestion
What are centrally acting adrenergic blockers (aka centrally acting sympatholytics)?
Meds that stimulate ___
