cardiovascular pharmacology Flashcards
what are anti-anginals used for?
to treat stable angina
Goal of pharmacotherapy of stable angina
Goal: relieve (nitrates, beta blockers, clacium channel blockers, ranolazine)
Goal: Reduce (lipid lowering drug, ASA or clopidogrel (plavix) )
Goal: Improve morbidity and mortality
(ace inhibitor or arb)
anti-anginals
What do nitrates do
dilates veins, which decreases preload
anti-anginals
What do beta blockers do
decrease heart rate and contractility
anti-anginals
What do calcium channel blockers do?
dilate arterioles, which decreases afterload
decrease heart rate and contractility
What do anti-anginals and
ranolazine do?
helps the myocardium generate energy more efficiently
meds to treat stable angina
nitrates and ranolazoine
** beta blockers, calcium channel blockers, statins, asa covered in fundamentals**
nitroglycerin
organic nitrates
first anginal agent
dilates veins and decreases preload
side effects of nitro
r/t vasodilation, Headache, hypotension, reflex tachycardia, tolerance
rapid acting nitro
sublingual
translingual
iv
nitrostat
rapid
sublingual
put under tongue
repeat every 5 min x3 PRN
types of short acting nitro
skin patch
ointment
transderm-nitro
skin patch
short acting
apply to chest or thigh area daily
nitro-bid
short acting
ointment
apply 1-2 inches to chest or thigh area
long acting nitro
isosorbide
sub lingual or oral
for prevention of anginal attacks
tolerance builds up over time
nursing implications for nitrates
headache- most subside after 20 min
apply nitro patch in AM and remove in PM (apply to hairless site and rotate)
IV form- glass bottle with special tubing, monitor for severe ha, tachycardia
long acting- taper when d/c to prevent increased CP from vasopressin
pt education for nitrates
treatment of acute chest pain take only as many SL tabs as needed do not swallow SL fall precautions- can make you dizzy/ hypotension no relief in 5 min call 911 DO NOT exceed 3 doses
Severe drug interactions of nitrates
severe hypotension when taken with sildenafil/viagra, antihypertensive and etoh
what is the most recent guideline for nitro
if chest pain is not relieved or worsened 5 min after taking the first nitro, call 911 and take another
ranolazine (ranexa)
anti-anginal
MOA unknown, possibly helps myocardium use energy more efficiently
warnings using ranolazine
prolonged QT intervals
acute renal failure with existing renal disease
liver cirrhosis
what do you need to avoid on ranolazine?
grapefruit juice and CYP inhibitors
side effects of ranolazine
ha, dizziness, nausea, constipation
pharmacology tx of HF
ace arb arni beta blockers mineralocorticoid receptor agonist SLGT2 inhibitors diuretics digitalis nitrates
ARNI’s
sacubitril/valsartan
*thought to be the best but are newer and more expensive
RAAS inhibitor
MOA of ARNI’s
decreases preload and afterload
suppresses aldosterone
Stops cardiac remodeling
use highest dose possible
side effects of ARNI’s
hypotension
hyperkalemia
cough (ACEI)
carvedilol
beta blocker
protects against SNS activation and dysrhythmias, reverses cardiac remodeling
side effects of carvedilol
fluid retention, worsening HF
fatigue
hypotension
bradycardia
spironolactone
mineralocorticoid receptor
used for the suppression of sodium/water retention to help with offloading the LV
what condition must watch for with spironolactone and what can it cause?
hyperkalemia and worsening renal failure
dapaglifozin
SLG2 inhibitor
MOA for HF not well understood
helps with ventricular unloading through osmotic diuresis without depleting volume
decreases readmissions, mortality and morbidity
first-line therapy of diuretics in HF
loop diuretics
furosemide
used for volume overload
No survival benefit!!
side effects of furosemide
hypokalemia
hypotension
digoxin toxicity
digitalis/ digoxin
inotropic drug
cardiac glycosides
second line drug therapy due to increased risk for dysrhythmia’s
what does positive inotropic effect mean?
if we increase contractility of heart muscle then we increase force of contraction increasing CO
what plant is digitalis made from?
foxglove
MOA of digitalis/digoxin
cardiac glycoside
inhibits sodium-potassium ATP pump causing calcium to collect within cells of heart helping to increase myocardial contractility
decreased HR
side effects of digitalis/digoxin
cardiac dysrhythmias
digitalis toxicity
who is at highest risk of digitalis toxicity
Increased age
women
combination drugs (digoxin and diuretic therapy)
how do you prevent digitalis toxicity
reduced dose
serum digitalis levels (periodic monitoring)
supplemental potassium
nursing implications when giving digoxin
monitor serum potassium levels take apical pulse 1 full minute prior to administering digoxin hold if pulse below 60 monitor cardiac rhythm TEACH pt to take own pulse before taking
what is the antidote for digitalis toxicity
digoxin immune fab (digibind) given IV
signs and symptoms of digitalis toxicity
bradycardia headache dizziness confusion nausea visual disturbances - blurry/yellow vision
meds to control rate and rhythm control
beta blockers calcium channel blockers amiodarone adenosine atropine dofetilide
what is the HR goal for beta blockers?
HR <100 and normal rhythm
amiodarone MOA
prolongs action potential duration and the effective refractory period in ALL cardiac tissues
blocks alpha and beta adrenergic receptors in the SNS
one of the most effective antidysrhythmic for PSVT and ventricular dysrhythmias used for afib with RVR
black box warning of amiodarone
pulmonary toxicity
hepatotoxicity
pro-arhythmic effects
2 significant drug interactions with amiodarone
digoxin and warfarin causing increased digoxin levels and increased INR
extremely long half life-lasts in system for 2-3 months
who is amiodarone contraindicated in?
people with severe bradycardia, or heart blocks
signs and symptoms of amiodarone toxicity
tremors ataxia blue-gray skin bradycardia hepatotoxicity ocular neuritis corneal microdeposits
atropine
for sinus brady (symptomatic only)
for rate and rhythm control
anticholenergic/antimuscarinic
given IV only for bradycardia 1mg every 3-5 min 3mg max
MOA of atropine
poisons the vagus nerve, inhibits postganglionic acetylcholine receptors and direct vagolytic action
side effects of atropine
xerostomia, blurry vision, photophobia, tachycardia, flushing, hot skin
nursing implications for atropine
cardiac monitoring, if med doesn’t work quickly give second dose
adenosine for PSVT
slows the conduction time through AV node
very short half life- may need multiple doses
only given IV
6mg IVP, if no conversion give 12mg IVP, can give 3rd time 12 mg IVP
ALWAYS follow with rapid normal saline flush or 2 saline flushes
what does adenosine cause?
short burst of ASYSTOLE until sinus rhythm returns
side effects of adenosine?
very few, can cause short bursts asystole
Have shock pads on pt incase rhythm doesn’t rerun
dofetilide (tikosyn)
antidysrhythmic
conversion from afib/aflutter to NSR
And to stay in NSR
Maintenance med
moa of dofetilide
selectively blocking the rapid cardiac ion channel carrying potassium currents
side effects of dofetilide
torsades, svt, headache, dizziness, chest pain
nursing implications of dofetilide
started in hospital with ECG monitoring r/t risk of Torsades
DONT give to patients with long QT intervals or other drugs that may prolong QT intervals
Amidodarone Side effects
Fat loving causing: Thyroid alterations Corneal micro deposits Pulmonary toxicity Hepatotoxicity
Torsades
Caused by dofetilide Form of Vtach Deadly CPR Very fast
A fib patients also need to take
Warfarin
