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Pharm- NCLEX Review > Cardiovascular Medications > Flashcards

Cardiovascular Medications Flashcards

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1
Q

What is anticoagulants?

A

Prevent extension and formation of clots by inhibiting factors in clotting cascade and decreasing blood coagulability.

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2
Q

When are anticoagulants used?

A

Evidence of or likelihood of clot formation:
MI
Unstable angina
Afib
DVTs (deep vein thrombosis)
PE (pulmonary embolism)
Presence of mechanical heart valves

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3
Q

Contraindications of anticoagulants?

A

Active bleeding (except disseminated intravascular coagulation DIC)
Bleeding disorders
Blood dycrasias
Ulcers
Liver and kidney disease
Hemorrhagic brain injuries

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4
Q

Common side effects and adverse effects of anticoagulants?

A

Hemorrhage
Hematuria (blood in urine)
Epistaxis (nose bleed)
Ecchymosis (bruising; bleeding under skin)
Bleeding gums
Thrombocytopenia (platelet count in blood too low)
Hypotension

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5
Q

Oral route

A

Apixaban
Dabigatran etexilate
Edoxaban
Rivaroxaban
Warfarin sodium

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6
Q

Parenteral route

A

Argatroban
Bivalirudin
Dalteparin
Desirudin
Enoxoparin
Fondaparinux
Heparin sodium

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7
Q

Heparin sodium (parenteral)

A

Prevents thrombin from converting fibrinogen to fibrin.
Normal aPTT is 30-40 seconds
THERAPEUTIC LEVEL receiving continuous infusion is aPTT 1.5-2.5 times normal value (depending on agency protocol).
MEASURE aPTT every 4-6 hours during initial infusion and then daily per agency policy.
MONITOR aPTT and platelet count.
OBSERVE for bleeding gums, bruises, epistaxis, hematuria, hematemesis, occult blood in stool, and petechiae.
ANTIDOTE is protamine sulfate.
INFUSION is always done with infusion pump and preprogrammed to ensure safe delivery rate.

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8
Q

Enoxaparin (parenteral)

A

Prevents thrombin from converting fibrinogen to fibrin.
Same action of heparin but longer half-life.
DO NOT expel air bubble from prefilled syringe.
Admin in abdomen subcu.
MONITOR aPTT and for bleeding.
TEACH pt to prevent bleeding.
ANTIDOTE is protamine sulfate.

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9
Q

Warfarin Sodium (Oral)

A

Suppresses coagulation by acting as an antagonist of vitamin K (inhibiting clotting factors X, IX, VII, & II).
MONITOR prothrombin time (PT) and international normalized ratio (INR).
Long term use.
PT 11-12.5 seconds
Therapeutic Range is 1.5 to 2 times control value.
INR 0.81-1.2 conventional and standard units
TEACH pt to prevent bleeding.
ANTIDOTE is phytonadione.
Routine monitoring is required.

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10
Q

Dabigatran etexilate

A

Works through direct inhibition of thrombin, preventing conversion of fibrinogen into fibrin and activation of factor XIII.
Clot prevention w/ nonvalvular a fib.
No testing is required.
OBSERVE for bleeding and TEACH client regarding ways measures to prevent bleeding.
ANTIDOTE for warfarin is phytonadione.

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11
Q

Substances to avoid with anticoagulants?

A

Allopurinol
Cimetidine
Corticosteroid
Fluoroquinolones
Green, leafy vegetables and other foods high in vitamin K
Gingko and ginseng (herbs)
Macrolide antibiotics
Oral hypoglycemic agents
Phenytoin
Salicylates
Sulfonamides

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12
Q

Thrombolytic medications

A

Alteplase
Reteplase
Tenecteplase

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13
Q

What are thrombolytic medications?

A

Activate plasminogen which generates plasmin (the enzyme that dissolves clots).

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14
Q

What are thrombolytic medications used for?

A

Used in early course of MI (within 4-6 hours of onset) to restore blood flow, limit damage, preserve left ventricular function, and prevent death.

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15
Q

What are contraindications of thrombolytic medications?

A

Active internal bleeding
Hx of stroke
Intracranial problems including trauma
Intracranial or intraspinal surgery within last 2 months.
Hx of thoracic, pelvic, or abdominal surgery.
Hx of hepatic or renal disease.
Uncontrolled HTN
Recent, prolonged cardiopulmonary resuscitation.
known allergy to product or its preservatives.

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16
Q

What are side effects of thrombolytic agents?

A

Bleeding
Dysrhythmias
Allergic Reactions

17
Q

What are interventions to use during the use of thrombolytic medications?

A

Determine aPTT, PT, fibrinogen level, hematocrit, and platelet count.
Monitor vitals
Check pulses
Monitor for bleeding
Monitor neurologic changes
Monitor for hypotension and tachycardia
Avoid injections and unnecessary venipunctures.
Apply pressure over a puncture site for 20-30 minutes.
When moving pt handle as little as possible.
Teach pt to use electric razor and brush teeth with soft tooth brush gently.
Hold medication if bleeding is present and contact HCP.
ANTIDOTE is amniocaproic acid

18
Q

What does an antiplatelet medication do?

A

Inhibits the aggregation of platelets in clotting process thereby prolonging bleeding time.
Used with anticoagulants.

19
Q

What are contraindications of antiplatelet medications?

A

Patients with bleeding disorders and known sensitivity.

20
Q

What are antiplatelet medications used for?

A

Prophylaxis of long-term complications after MI, coronary revascularization, stents, and stroke.

21
Q

What are common adverse effects of antiplatelet medications?

A

GI Bleeding
Bruising
Hematuria
Tarry Stools

22
Q

What are interventions to use for antiplatelet medication use?

A

Blood test for sensitivity.
Monitor vital signs.
Teach to take with food if GI upset occurs.
Monitor bleeding time
Reinforce instructions to client to monitor for side effects related to bleeding and measures to prevent bleeding.

23
Q

What do cardiac glycosides do?

A

Inhibits the sodium-potassium pup, thus increasing intracellular calcium which causes the heart muscle fibers to contract more efficiently.
Increases the force of myocardial contractions and slows the heart rate.

24
Q

What medications are cardiac glycosides?

A

Digoxin

25
Q

What is digoxin (cardiac glycoside) used for?

A

Increases cardiac, peripheral, and kidney function by increasing cardiac output, decreasing preload, improving blood flow to periphery and kidneys, decreasing edema, and increasing fluid excretion.
Reduces fluid retention in lungs and extremities.

26
Q

What medications are cardiac glycosides?

A

Second line for HF and cardiogenic shock, atrial tachycardia, atrial fibrillation, and atrial flutter.

27
Q

Contraindications of digoxin?

A

Ventricular dysrhythmias and second- or third- degree heart block.
Use with caution in patients with renal disease, hypothyroidism and hypokalemia.

28
Q

What are side and adverse effects of digoxin?

A

Anorexia, nausea, vomiting, diarrhea
Headache
Visual disturbances including diplopia, blurred vision, yellow-green halos, photophobia
Drowsiness
Bradycardia
Fatigue, weakness

29
Q

What are early signs of digoxin toxicity?

A

GI manifestations (anorexia, nausea, vomiting, diarrhea) then heart rate abnormalities and visual disturbances appear.

30
Q

What are interventions to consider with digoxin?

A

Monitor for toxicity: anorexia
vomiting, visual disturbances, confusion, bradycardia, heart block, premature ventricular contractions, and tachydysrhythmia.

31
Q

What is the therapeutic range for digoxin?

A

0.5-2.0 ng/mL
Low end of normal preferred to avoid toxicity

32
Q

What electrolytes

A

potassium level (3.5-5 mEq/L); if hypokalemia occurs notify the HCP

33
Q

What to teach patients on digoxin?

A

Avoid taking OTC meds
Advise the client to eat foods high in potassium such as fresh and dried fruits, fruit juices, vegetables and potatoes.
Teach pt how to monitor pulse and to notify the HCP if less than beats/min.
Teach S/S of dig toxicity.

34
Q

What is the antidote for digoxin?

A

Digoxin immune Fab is used in extreme toxicity.

Pharm- NCLEX Review (1 decks)

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