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Medical Surgical Nursing > Cardiovascular Medications > Flashcards

Cardiovascular Medications Flashcards

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1
Q

Refers to the stopping of blood flow. It is an essential mechanism that protects the body from both external and internal injury.

Is also achieved once a blood clot is formed and the body is protected from excessive hemorrhage.

A

Hemostasis

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2
Q

Also known as Clotting, this refers to the process by which blood changes from a liquid to a gel, forming a blood clot.

A

Coagulation

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3
Q

Refers to the series of steps in response to bleeding caused by tissue injury, where each step activates the next and ultimately produces a blood clot.

A

Coagulation Cascade

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4
Q

What substance does the liver require to make four of the clotting factors?

A

Vitamin K

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5
Q

Refers to the coagulation pathway that is activated in response to injury.

A

Intrinsic Pathway

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6
Q

Refers to the coagulation pathway that is activated when blood leaks out of a vessel and enters tissue spaces.

A

Extrinsic Pathway

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7
Q

Also known as clotting factor I, forms fibrin that binds together platelets and some plasma proteins in a hemostatic plug.

A

Fibrinogen

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8
Q

Also known as clotting factor II, activates thrombin.

A

Prothrombin

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9
Q

Is a chemical responsible for converting the clotting factor prothrombin into an enzyme called thrombin

A

Prothrombin Activator / Prothrombinase

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10
Q

Refers to an enzyme that converts fibrinogen, a plasma protein, to fibrin

A

Thrombin

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11
Q

What is the approximate time in which normal blood clotting occurs?

A

6 Minutes

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12
Q

Refers to drugs that are used to prolong bleeding time and thereby prevent blood thrombi from forming or growing larger.

These drugs impart a negative charge to the surface of the platelets, which inhibits the clumping action or aggregation of these cells.

A

Anticoagulants

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13
Q

Is the traditional drug of choice for parenteral anticoagulation. It is administered intravenously or subcutaneously to achieve a rapid onset of action.

This drug acts by enhancing the actions of antithrombin III. A protein in plasma that inactivates thrombin, and several other procoagulant enzymes, and inhibits coagulation.

A

Heparin Sodium

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14
Q

Refers to shortened and modified heparin molecules. Are a newer class of drugs related to heparin.

A

Low-Molecular-Weight-Heparins (LMWHs)

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15
Q

Another name for heparin. Is used to distinguish it from LMWHs

A

Unfractionated Heparin

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16
Q

What is the action of Heparin? And what is its onset of action?

A

Heparin binds to Antithrombin III, resulting in the inactivation of several clotting factors and inhibits thrombin activity.

The onset of action for IV Heparin is immediate, whereas subcutaneous heparin may take up to 1 hour to achieve a therapeutic effect

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17
Q

What are some Nursing Interventions for Heparin Sodium?

A
  • Monitor aPPT (Activated partial thromboplastin time)
  • Monitor platelet count
  • When administering heparins via SC, inject into abdomen with a 25-28 G needle at a 90 degree angle. Do not aspirate once the needle has entered the skin and never massage the site after injection
  • Observe for signs of bleeding: gums, bruises, nosebleeds, hematuria, hematemesis, occult blood in stool and petechia
  • If aPPT is longer than 80 seconds, lower the dosage, if less than 60 seconds, increase the dosage
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18
Q

Name a contraindication for Heparin Sodium

A

IM administration is contraindicated due to bleeding risk

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19
Q

What is the antidote for Heparin Sodium?

A

Protamine Sulfate

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20
Q

What is the normal aPPT? (Activated partial thromboplastin time)

A

20 - 40 seconds. may vary in different sources, but essentially are within this range

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21
Q

What type of drug is Enoxaparin Sodium?

A

LMWHs (Low-Molecular-Weight-Heparins)

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22
Q

This drug’s mechanism of action and use are similar to that of heparin, but is not interchangeable. It’s inhibition is more specific to active Factor X and has a longer half-life than heparin.

A

Enoxaparin Sodium

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23
Q

Refers to the most commonly prescribed oral anticoagulant

A

Warfarin Sodium

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24
Q

Why do both heparin and warfarin therapy sometimes overlap?

A

Because unlike heparin that can act either immediately or within an hour, the anticoagulant activity of warfarin can take several days to reach its maximum effect.

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25
Q

What is the action of Warfarin? And what is its onset of action?

A

Warfarin inhibits the action of vitamin K. Without adequate vitamin K, the synthesis of clotting factors II, VII, IX, and X is diminished.

Because these clotting factors are normally circulating in the blood, it takes several days for their plasma levels to fall and for the anticoagulant effect of warfarin to appear.

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26
Q

What are some Nursing Interventions for Warfarin Sodium?

A
  • Observe for signs of bleeding: bleeding gums, bruises, nosebleeds, hematuria, hematemesis, occult blood in stool, and petechia.
  • Instruct patient regarding diet and measures to prevent bleeding.
  • If life-threatening bleeding occurs during therapy, the anticoagulant effects of warfarin can be reduced by intramuscular (IM) or subcutaneous administration of its antagonist, Vitamin K1.
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27
Q

What is the antidote for Warfarin Sodium?

A

Vitamin K

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28
Q

What is the normal INR (International Normalized Ratio) of the average person?

A

1.3 - 2.0 seconds However, the treatment goal of warfarin sodium is to raise the INR to an appropriate value—2 to 3 seconds. Which is appropriate for most patients

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29
Q

List the anticoagulant drugs that were mentioned in this deck.

A
  • Heparin Sodium
  • Enoxaparin Sodium
  • Warfarin Sodium
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30
Q

Refers to drugs that promotes the process of fibrinolysis, or clot destruction, by converting plasminogen into plasmin, an enzyme that digests fibrin and breaks it down into small soluble fragments

A

Thrombolytics

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31
Q

What enzyme digests fibrin, and breaks it down into small soluble fragments?

A

Plasmin

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32
Q

When are thrombolytics used in the course of MI?

A

Within 4 to 6 hours of the onset of the infarction.

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33
Q

Refers to a thombolytic drug used for dissolving clots.

Is also the preferred drug for the treatment of stroke, arterial thrombosis, deep vein thrombosis, occluded shunts or catheters and pulmonary emboli.

A

Alteplase

34
Q

What are the Nursing Interventions for Alteplase?

A
  • Observe for signs of bleeding: bleeding gums, bruises, nosebleeds, hematuria? hematemesis, occult blood in stool, and petechia
  • Instruct patient regarding diet and measures to prevent bleeding.
  • Monitor for neurological changes such as slurred speech, lethargy, confusion, and hemiparesis
  • Monitor vital signs closely and assess pulses
  • Must give drug within 12 hours of onset of symptoms of MI and within 3 hours of thrombotic stroke for maximum effectiveness
  • Apply direct pressure over a puncture site for 20-30 minutes.
35
Q

What is the antidote for Alteplase?

A

Aminocaprioc Acid (Amicar). Is used only in acute life threatening conditions.

36
Q

What are some of the contraindications of Alteplase?

A
  • Active internal bleeding
  • History of hemorrhage brain attack (stroke)
  • Uncontrolled hypertension
  • Intracranial problems, including trauma
  • History of hepatic or renal disease
  • Recently acquired, prolonged CPR
  • Intracranial or Intraspinal surgey within the previous 2 months
  • History of thoracic, pelvic, or abdominal surgery in the previous 10 days
37
Q

Refers to a type of drug that produces an anticoagulant effect by interfering with platelet aggregation. Are used to prevent clot formation in the arteries, and may be used with anticoagulants.

A

Antiplatelet Drugs

38
Q

What is the difference between the locations in which Antiplatelet and Anticoagulant drugs act upon?

A
  • Anticoagulants prevent thrombosis in veins.
  • Antiplatelet drugs prevent clot formation in arteries.
39
Q

Refers to an Antiplatelet Drug that acts by binding irreversibly to the enzyme cyclooxygenase in platelets. Resulting in the formation of Thromboxane A, a powerful inducer of platelet aggregation.

A

Aspirin

40
Q

Refers to an Antiplatelet Drug that prolongs bleeding time by inhibiting platelet aggregation, directly inhibiting ADP binding to its receptor. Said binding is irreversible, and the platelet will be affected for the remainder of its life span.

A

Clopidogrel

41
Q

Refers to a drug that is usually prescribed for patients who are unable to tolerate aspirin, which has similar anticoagulant activity. It is given PO OD.

A

Clopidogrel

42
Q

List some indications for the drug Aspirin.

A
  • Is a drug prototype for pain relief
  • Used for prevention of strokes
  • Used for prevention of MI
  • Used for reducing inflammation
43
Q

Refers to a small group of drugs that irreversibly alter the plasma membrane of platelets. An alteration that changes the binding of ADP to its receptor on platelets. Making them unable to receive the chemical signals required for them to aggregate.

A

ADP Receptor Blockers

44
Q

What is the primary concern for a client taking an anticoagulant, thrombolytic. or antiplatelet medication?

A

Bleeding

45
Q

Refers to a change in contractility of the heart.

A

Inotropic Effect

46
Q

Refers to drugs that increases the contractility of the heart.

A

Positive Inotropic Agents

47
Q

Give an example of Positive Inotropic Agents.

A
  • Epinephrine
  • Norepinephrine
  • Dopamine
  • Thyroid Hormone
48
Q

Refers to drugs that are used for short term management of heart failure. Which increases myocardial contractility, improves cardiac, peripheral, and kidney function by increasing cardiac output, decreasing preload, improving blood flow to the periphery and kidneys, decreasing edema, and increasing fluid retention. Resulting in fluid retention to be decreased in the lungs and extremities.

A

Positive Inotropic Agents

49
Q

Refers to a drug that is used as a short term rescue measure for clients with severe, acute heart failure. This drug increases myocardial contractility, thereby improving cardiac performance.

A

Dopamine

50
Q

In what route do positive inotropic and cardiotonic medications administered in?

A

Intravenous Administration

51
Q

Is a positive inotropic agent. A drug that inhibits the sodium-potassium pump, increasing intracellular calcium, causing the heart muscles to contract more efficiently (Increases the force of myocardial contractions).

A

Digoxin

52
Q

Why is Digoxin sometimes used to treat dysrhythmias?

A
  • Because of its ability to suppress the SA node
  • Because it slows electrical conduction through the AV node
53
Q

What is the antidote for Digoxin toxicity?

A

Digoxin Immune Fab

54
Q

What are the classifications of Diuretics?

A
  • Loop Diuretics
  • Osmotic Diuretics
  • Potassium-retaining Diuretics
  • Thiazide Diuretics
55
Q

Refers to Diuretics that increase sodium and water excretion by inhibiting sodium reabsorption in the distal tubule of the kidney.

A

Thiazide Diuretics

56
Q

Why should Thiazide Diuretics be used with caution in patients taking lithium?

A

Because Lithium Toxicity can occur.

57
Q

Refers to diuretics more potent than thiazide diuretics. They increase sodium and chloride reabsorption from the loop of Henle and the distal tubule

A

Loop Diuretics

58
Q

Are diuretics that act on the distal tubule to promote sodium and water excretion, and potassium retention.

They are used for edema and hypertension to increase urine output, and to treat fluid retention and overload.

A

Potassium-retaining Diuretics

59
Q

What are the contraindications for Potassium-retaining Diuretics?

A
  • Severe Kidney or Hepatic Disease
  • Severe Hyperkalemia
60
Q

Refers to drugs that decrease sympathetic vasoconstriction by reducing the effects of norepinephrine at peripheral nerve endings, resulting in vasodilation and decreased BP.

A

Peripherally Acting Alpha Adrenergic Blockers

61
Q

Refers to drugs that stimulate alpha receptors in the central nervous system to inhibit vasoconstriction, thus reducing peripheral resistance.

A

Centrally Acting Sympatholytic (Adrenergic Blockers)

62
Q

Why are patients using Centrally Acting Sympatholytic (Adrenergic Blockers) instructed not to discontinue medication?

A

Because abrupt withdrawal can cause severe rebound hypertension.

63
Q

Are drugs that prevents peripheral vasoconstriction by blocking conversion of angiotensin I to angiotensin II.

A

Angiotensin - Converting Enzyme Inhibitors

64
Q

Refers to drugs that prevent peripheral vasoconstriction and secretion of aldosterone. Also blocks the binding of AT1 receptors.

A

Angiotensin II Receptor Blockers

65
Q

Is a type of Antianginal Medication that produces vasodilation, decreases preload and afterload, and reduces myocardial oxygen consumption.

A

Nitrates (Nitroglycerin)

66
Q

Why do we instruct patients to check the expiration date of nitroglycerin tablets?

A

Because expiration may occur within 6 months of obtaining the medication. The tablets by that point will not relieve chest pain, if expired.

67
Q

Are drugs that inhibit the response to beta adrenergic stimulation, decreasing cardiac output.

These drugs block the release of catecholamines, epinephrine, and norepinephrine, thus decreasing the heart rate and BP. They also decrease the workload of the heart and decrease oxygen demands.

A

Beta Adrenergic Blockers

68
Q

Is a type of Antianginal Medication that induces a negative inotropic effect by relaxing smooth muscle, thus decreasing cardiac contractility and the workload of the heart. Reducing the need for oxygen.

A

Calcium Channel Blockers

69
Q

Refers to drugs that decrease peripheral resistance by exerting a direct action on the arteries or on the arteries and the vein.

These drugs also increase blood flow to the extremities and are used in peripheral vascular disorders of venous and arterial vessels.

A

Peripheral Vasodilators

70
Q

Are drugs that relax the smooth muscles of the blood vessels, mainly the arteries, causing vasodilation. With vasodilation, BP drops, and sodium and water are retained, resulting in peripheral edema. (Diuretics may be given to reduce the edema)

These drugs promote an increase in blood flow to the brain and kidneys.

A

Direct - Acting Arteriolar Vasodilators

71
Q

When it comes to vasodilators, why do we have to instruct the patient about safety measures when taking Direct - Acting Arteriolar vasodilators?

A

Because vasodilators cause orthostatic hypotension. As such, patients should be instructed when they are rising from lying to a sitting or standing position to slowly do so.

72
Q

Refers to drugs that suppress dysrhythmias by inhibiting abnormal pathways of electrical conduction through the heart.

A

Antidysrhythmic Medications

73
Q

What are the classes of Antidysrhythmic Medications?

A
  • Class I : Sodium Channel Blockers
  • Class II : Beta Blockers
  • Class III : Potassium Channel Blockers (Medications that delay repolarization)
  • Class IV : Calcium Channel Blockers
74
Q

Why are antidysrhythmics not administered with food?

A

Because food may affect absorption

75
Q

Refers to drugs that reduce serum levels of cholesterol, triglycerides, or low-density lipoprotein.

A

Antilipemic Medications

76
Q

Refers to an Antilipemic Medication that binds with acids in the intestines, which prevents reabsorption of cholesterol.

A

Bile Sequestrants

77
Q

Refers to an Antilipemic Medication that blocks an enzyme called HMG-CoA reductase. Which is responsible for synthesizing cholesterol in the liver.

A

HMG-CoA Reductase Inhibitors

78
Q

Why are patients using HMG-CoA Reductase Inhibitors instructed to have an annual eye examination?

A

Because these medications can cause cataract formation.

79
Q

Give examples of Antilipemic Medications

A
  • Gemfibrozil
  • Lovastatin (HMG-CoA Reducatse Inhibitor)
  • Cholestyramine (Bile Sequestrant)
  • Nicotinic Acid
80
Q

Why should Gemfibrozil not be taken with anticoagulants?

A

Because they compete for protein sites.

81
Q

Why should Gemfibrozil not be administered with HMG-CoA Reductase Inhibitors?

A

Doing so increases the risk for myositis, myalgias, and rhabdomyolysis

Medical Surgical Nursing (2 decks)

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