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NUR326 Cardiac > cardiovascular pharmacology > Flashcards

cardiovascular pharmacology Flashcards

1
Q

what are anti-anginals used for?

A

to treat stable angina

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2
Q

Goal of pharmacotherapy of stable angina

A

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)

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3
Q

anti-anginals

What do nitrates do

A

dilates veins, which decreases preload

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4
Q

anti-anginals

What do beta blockers do

A

decrease heart rate and contractility

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5
Q

anti-anginals

What do calcium channel blockers do?

A

dilate arterioles, which decreases afterload

decrease heart rate and contractility

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6
Q

What do anti-anginals and

ranolazine do?

A

helps the myocardium generate energy more efficiently

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7
Q

meds to treat stable angina

A

nitrates and ranolazoine

** beta blockers, calcium channel blockers, statins, asa covered in fundamentals**

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8
Q

nitroglycerin

A

organic nitrates
first anginal agent
dilates veins and decreases preload

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9
Q

side effects of nitro

A

r/t vasodilation, Headache, hypotension, reflex tachycardia, tolerance

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10
Q

rapid acting nitro

A

sublingual
translingual
iv

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11
Q

nitrostat

A

rapid
sublingual
put under tongue
repeat every 5 min x3 PRN

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12
Q

types of short acting nitro

A

skin patch

ointment

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13
Q

transderm-nitro

A

skin patch
short acting
apply to chest or thigh area daily

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14
Q

nitro-bid

A

short acting
ointment
apply 1-2 inches to chest or thigh area

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15
Q

long acting nitro

A

isosorbide
sub lingual or oral
for prevention of anginal attacks
tolerance builds up over time

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16
Q

nursing implications for nitrates

A

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

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17
Q

pt education for nitrates

A 
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
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18
Q

Severe drug interactions of nitrates

A

severe hypotension when taken with sildenafil/viagra, antihypertensive and etoh

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19
Q

what is the most recent guideline for nitro

A

if chest pain is not relieved or worsened 5 min after taking the first nitro, call 911 and take another

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20
Q

ranolazine (ranexa)

A

anti-anginal

MOA unknown, possibly helps myocardium use energy more efficiently

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21
Q

warnings using ranolazine

A

prolonged QT intervals
acute renal failure with existing renal disease
liver cirrhosis

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22
Q

what do you need to avoid on ranolazine?

A

grapefruit juice and CYP inhibitors

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23
Q

side effects of ranolazine

A

ha, dizziness, nausea, constipation

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24
Q

pharmacology tx of HF

A 
ace
arb
arni
beta blockers
mineralocorticoid receptor agonist
SLGT2 inhibitors
diuretics 
digitalis
nitrates
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25
Q

ARNI’s

A

sacubitril/valsartan
*thought to be the best but are newer and more expensive
RAAS inhibitor

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26
Q

MOA of ARNI’s

A

decreases preload and afterload
suppresses aldosterone
Stops cardiac remodeling
use highest dose possible

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27
Q

side effects of ARNI’s

A

hypotension
hyperkalemia
cough (ACEI)

28
Q

carvedilol

A

beta blocker

protects against SNS activation and dysrhythmias, reverses cardiac remodeling

29
Q

side effects of carvedilol

A

fluid retention, worsening HF
fatigue
hypotension
bradycardia

30
Q

spironolactone

A

mineralocorticoid receptor

used for the suppression of sodium/water retention to help with offloading the LV

31
Q

what condition must watch for with spironolactone and what can it cause?

A

hyperkalemia and worsening renal failure

32
Q

dapaglifozin

A

SLG2 inhibitor
MOA for HF not well understood
helps with ventricular unloading through osmotic diuresis without depleting volume
decreases readmissions, mortality and morbidity

33
Q

first-line therapy of diuretics in HF

A

loop diuretics
furosemide
used for volume overload
No survival benefit!!

34
Q

side effects of furosemide

A

hypokalemia
hypotension
digoxin toxicity

35
Q

digitalis/ digoxin

A

inotropic drug
cardiac glycosides
second line drug therapy due to increased risk for dysrhythmia’s

36
Q

what does positive inotropic effect mean?

A

if we increase contractility of heart muscle then we increase force of contraction increasing CO

37
Q

what plant is digitalis made from?

A

foxglove

38
Q

MOA of digitalis/digoxin

A

cardiac glycoside
inhibits sodium-potassium ATP pump causing calcium to collect within cells of heart helping to increase myocardial contractility
decreased HR

39
Q

side effects of digitalis/digoxin

A

cardiac dysrhythmias

digitalis toxicity

40
Q

who is at highest risk of digitalis toxicity

A

Increased age
women
combination drugs (digoxin and diuretic therapy)

41
Q

how do you prevent digitalis toxicity

A

reduced dose
serum digitalis levels (periodic monitoring)
supplemental potassium

42
Q

nursing implications when giving digoxin

A 
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
43
Q

what is the antidote for digitalis toxicity

A

digoxin immune fab (digibind) given IV

44
Q

signs and symptoms of digitalis toxicity

A 
bradycardia
headache
dizziness
confusion
nausea
visual disturbances - blurry/yellow vision
45
Q

meds to control rate and rhythm control

A 
beta blockers
calcium channel blockers
amiodarone
adenosine
atropine
dofetilide
46
Q

what is the HR goal for beta blockers?

A

HR <100 and normal rhythm

47
Q

amiodarone MOA

A

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

48
Q

black box warning of amiodarone

A

pulmonary toxicity
hepatotoxicity
pro-arhythmic effects

49
Q

2 significant drug interactions with amiodarone

A

digoxin and warfarin causing increased digoxin levels and increased INR
extremely long half life-lasts in system for 2-3 months

50
Q

who is amiodarone contraindicated in?

A

people with severe bradycardia, or heart blocks

51
Q

signs and symptoms of amiodarone toxicity

A 
tremors
ataxia
blue-gray skin
bradycardia
hepatotoxicity
ocular neuritis
corneal microdeposits
52
Q

atropine

A

for sinus brady (symptomatic only)
for rate and rhythm control
anticholenergic/antimuscarinic
given IV only for bradycardia 1mg every 3-5 min 3mg max

53
Q

MOA of atropine

A

poisons the vagus nerve, inhibits postganglionic acetylcholine receptors and direct vagolytic action

54
Q

side effects of atropine

A

xerostomia, blurry vision, photophobia, tachycardia, flushing, hot skin

55
Q

nursing implications for atropine

A

cardiac monitoring, if med doesn’t work quickly give second dose

56
Q

adenosine for PSVT

A

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

57
Q

what does adenosine cause?

A

short burst of ASYSTOLE until sinus rhythm returns

58
Q

side effects of adenosine?

A

very few, can cause short bursts asystole

Have shock pads on pt incase rhythm doesn’t rerun

59
Q

dofetilide (tikosyn)

A

antidysrhythmic
conversion from afib/aflutter to NSR
And to stay in NSR
Maintenance med

60
Q

moa of dofetilide

A

selectively blocking the rapid cardiac ion channel carrying potassium currents

61
Q

side effects of dofetilide

A

torsades, svt, headache, dizziness, chest pain

62
Q

nursing implications of dofetilide

A

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

63
Q

Amidodarone Side effects

A 
Fat loving causing: 
Thyroid alterations
Corneal micro deposits 
Pulmonary toxicity 
Hepatotoxicity
64
Q

Torsades

A 
Caused by dofetilide
Form of Vtach
Deadly
CPR
Very fast
65
Q

A fib patients also need to take

A

Warfarin

NUR326 Cardiac (6 decks)

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