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NCLEX Pharm > Cardiovascular > Flashcards

Cardiovascular Flashcards

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1
Q

What are anticoagulants?

A

Meds that prevent the extension and formation of clots by inhibiting factors in the clotting cascade and decreasing blood coagulability.

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2
Q

Uses of anticoagulants

As in to treat which issues

A

MI, unstable angina, atrial fibrillation, DVT, pulmonary embolism, when the pt has mechanical heart valves

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3
Q

Contraindications of anticoagulants

A

With active bleeding, bleeding disorders, blood dyscrasias, ulcers, liver and kidney disease, hemorrhagic brain injuries

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4
Q

Side effects of anticoagulants

A

Hemorrhage, hematuria, epistaxis, ecchymosis, bleeding gums, thrombocytopenia, hypotension

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5
Q

What is Heparin Sodium?

A

Anticoagulant that prevents thrombin from converting fibrinogen to fibrin

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6
Q

What is the normal activated partial thromboplastin time (aPTT)?
- How much higher should it be for therapeutic levels?

A

30-40 seconds

- Should be 1.5-2.5 times the normal value

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7
Q

How often do we measure aPTT during initial Heparin infusion therapy?

A

Every 4-6 hours

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8
Q

At what points (too high and too low) should we change the dosage of Heparin?

A

Above 90 seconds: dosage needs to be lowered

Below 60 seconds: dosage needs to be increased

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9
Q

Monitoring for Heparin

A

Bleeding gums, bruises, nosebleeds, hematuria, hematemesis, occult blood in stool, petechia

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10
Q

What is the antidote for Heparin?

A

Protamine sulfate

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11
Q

Name the (4) oral anticoagulants

A

Warfarin sodium, Dabigatran etexilate mesylate, Rivaroxaban, Apixaban

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12
Q

Name the (7) parenteral anticoagulants

A

Argatroban, Bivalirudin, Dalteparin, esirudin, Enoxaparin, Fondaparinux, Heparin sodium

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13
Q

What is Enoxaparin?

- How is it different from Heparin?

A

Anticoagulant that prevents thrombin from converting fibrinogen to fibrin
- Differs from heparin as it has a longer half-life

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14
Q

Where does Enoxaparin need to be administered?

A

Has to be given via subcutaneous injection into either the anterolateral or posterolateral abdominal wall

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15
Q

What is the antidote for Enoxaparin?

A

Protamine sulfate

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16
Q

What is Warfarin Sodium?

A

Anticoagulant that suppresses coagulation by acting as an antagonist for vitamin K by inhibiting four dependent clotting factors

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17
Q

Uses of Warfarin

A

Prevention of thrombophlebitis, pulmonary embolism, and embolism caused by atrial fibrillation, thrombosis, MI or heart valve damage

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18
Q

What is the normal prothrombin time (PT)?

- How much higher should it be for therapeutic levels?

A

11-12.5 second

- Therpeutic range is 1.5-2 times the normal

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19
Q

What is the normal International normalized ratio (INR)?

- How much higher should it be for therapeutic levels?

A
  1. 8-1.2
    - Standard therapy is 2-3 times normal
    - High dose therapy is 3-4.5 times normal
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20
Q

When should be initiate bleeding precautions?

A

When the PT is longer than 30 seconds or the the INR is greater than 3.0

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21
Q

What is ‘bridge therapy’?

A

When heparin is being used at the same time as warfarin until therapeutic INR is reached then the heparin is stopped

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22
Q

What is the antidote for warfarin?

A

Phytonadione

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23
Q

What is Dabigatran etexilate?

A

Anticoagulant that works through direct inhibition of thrombin, preventing conversion of fibrinogen to fibrin

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24
Q

Uses of Dabigatran

A

Clot prevention associated with nonvalvulr atril fibrillation

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25
Q

What is the major benefit of Dabigatran?

A

There is not blood work needed for serum monitoring

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26
Q

What is Rivaroxaban?

A

Anticoagulant that works through inhibition of factor Xa

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27
Q

Uses of Rivaroxaban

A

Clot prevention associated with nonvalvular atrial fibrillation and post-joint major joint replacement

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28
Q

What are thrombolytics?

A

Meds tht activate plasminogen, which in turn activates plasmin (which dissolves clots)

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29
Q

Name the (2) thrombolytics

A

Alteplase and Tenecteplase

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30
Q

Uses of thrombolytics

A

Early treatment of MI (first 4-6 hours), restore blood flow, limit myocardial damage, atrial trhombosis, DVT, occluded shunts or catheters, and pulmonary emboli

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31
Q

Contraindications of thrombolytics

A

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

32
Q

Side effects of thrombolytics

A

Bleeding, dysrhythmias, allergic reactions

33
Q

Monitoring for thrombolytics

A

aPTT, PT, fibrinogen level, hematocrit, and platelet count

34
Q

When a pt is on thrombolytics and a puncture is determined necessary what must we do?

A

Hold pressure over the site for 20-30 minutes

35
Q

What is the antidote for thrombolytics?

A

Aminocaproic acid

36
Q

What are antiplatelet medications?

A

Meds that inhibit the aggregation of platelets in the clotting process, thereby prolonging the bleeding time

37
Q

Name the (8) oral antiplatelet meds

A

ASA, Anagrelide, Cilostazol, Clopidogrel, Dipyridamole, Ticlipodine, Ticagrelor, Persantine

38
Q

Name the (3) parenteral antiplatelet meds

A

Abciximab, Eptifibatide, Tirofiban

39
Q

Uses of antiplatelet medications

A

Complications following MI, coronary revascularization, stents and stroke

40
Q

Contraindications of antiplatelet meds

A

Bleeding disorders

41
Q

Side effects of antiplatelet meds

A

Bruising, hematuria, GI bleeding, tarry stools

42
Q

What are positive inotropic and cardiotonic medications?

A

Meds that stimulate myocardial contractility and produce positive inotropic effect

43
Q

Uses of positive inotropic meds

A

Short-term management of advaned heart failure; improves cardiac, peripheralm and kidney function; decreases preload, increases cardiac output, decrease edema and increase fluid secretion

44
Q

What is Dopamine?

A

Positive inotrope, increases myocardial contractility, dilates renal blood vessels

45
Q

What is Dobutamine?

A

Positive inotrope, increases myocardial contractility

46
Q

What is Milrinone lactate?

A

Positive inotrope, used for short-term management of heart failure

47
Q

Side effects of positive inotropes

A

Dysrhythmias, hypotension, thrombocytopenia, hepatotoxicity,

48
Q

What cannot be mixed with Inamrinone?

A

Glucose-containting solutions

49
Q

What is a cardiac glycoside?

- What is the name of the common cardiac glycoside?

A

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

50
Q

What does increased contractility do for the body?

A

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

51
Q

Uses of cardiac glycosides

A

Heart failure, cardiogenic shock, atrial tachycardia, atrial fibrillation, atrial flutter, used less frequently for rate control

52
Q

Side effects of cardiac glycosides

A

Anorexia, N+V, bradycardia, visual disturbances, headache, fatigue, weakness, drowsiness

53
Q

What are the earliest signs of digoxin toxicity?

A

GI manifestations (anorexia, N+V, diarrhea)

54
Q

What is the therapeutic range for Digoxin?

A

0.5-0.8 ng/mL

55
Q

Which conditions increase the likelihood of Digoxin toxicity?

A

Hypercalcemia, hypokalemia, hypomagnesemia, and hypothyroidism

56
Q

What serum potassium equals hypokalemia?

A

Serum potassium below 3.5meq/L (3.5 mmol/L)

57
Q

What are the 4 classifications of diuretics?

A

Loop diuretics, osmotic diuretics, potassium-retaining diuretics, thiazide diuretics

58
Q

What are Thiazide diuretics?

- Uses

A

Increase sodium and water excretion by inhibiting sodium reabsorption in the distal tubule of the kidney.
- HTN, peripheral edema

59
Q

Name the (5) Thiazide diuretics

A

Chlorothiazide, Chlorthalidone, Hydrochlorothiazide, Indapamide, Metolazone

60
Q

Adverse effects of Thiazide diuretics

A

Hypercalcemia, hyperglycemia, hyperuricemia, hypokalemia, hyponatremia, hypovolemia, hypotension,

61
Q

When should Thiazide diuretics be administered?

A

In the morning with food

62
Q

What are Loop diuretics?

- How are they different from thiazide diuretic?

A

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

63
Q

Uses of Loop diuretics

A

HTN, pulmonary edema, edema associated with heart failure, hypercalcemia, and renal disease

64
Q

Side effects of loop diuretics

A

Hypokalemia, hyponatremia, hypocalcemia, hypomagnesemia, thrombocytopenia, hyperurecemia, orthostatic hypotension, ototoxicity, thiamine deficiency

65
Q

Name the (4) Loop diuretics

A

Bumetanide, Ethacrynic acid, Furosemide, Torsemide

66
Q

How should IV Furosemide be administered?

A

Slowly over 1-2 minutes. Or it could cause hearing loss.

67
Q

What are potassium-retaining diuretics?

- Uses

A

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,

68
Q

Contraindications of potassium-retaining diuretics

A

Severe kidney or hepatic disease, severe hyperkalemia, diabetes, taking antihypertensive, taking lithium, taking ACE inhibitors, taking potassium supplements

69
Q

Side effets of potassium-retaining diuretics

A

Hyperkalemia, N+V, diarrhea, rash, dizziness, headache, dry mouth, anemia, thrombocytopenia

70
Q

What are the signs and symptoms of hyperkalemia?

A

Nausea, diarrhea, abdominal cramps, tachycardia and peaked T waves on ECG

71
Q

What serum level indicates hyperkalemia?

A

Serum potassium above 5.0 mEq/L (5.0 mmol/L)

72
Q

Name the (5) potassium-retaining diuretics

A

Amiloride hydrochloride/hydrochlorothiazide, Eplerenone, Spironolactone, Spironolactone/hydrocholorthiazide, Triamterene

73
Q

What are Peripherally acting alpha-adrenergic blockers?

A

Meds tht decrease sympathetic vasoconstriction by reducing the effects of norepinephrine at peripheral nerve endings, resulting in vasodilation and decreased BP.

74
Q

Name the (3) peripherally acting alpha-adrenergic blockers

A

Doxazosin, Prazosin, Terazosin

75
Q

Side effects of peripherally acting alpha-adrenergic blockers

A

Orthostatis hypotension, reflex tachycardia, edema, sodium and water retention, edema, weight gain, GI disturbances, drowsiness, nasal congestion

76
Q

What are centrally acting adrenergic blockers (aka centrally acting sympatholytics)?

A

Meds that stimulate ___

NCLEX Pharm (7 decks)

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