Cardiovascular PPTS Flashcards
Thrombosis
Formation of a clot
Any vessel
Most common type - venous thrombosis (DVT)
Anticoagulants
Blood thinners
Inhibit clot formation
Prevent extension of clot
Prevent additional clots from forming
Heparin
Inhibit clot formation
Interferes fibrinogen conversion into
fibrin
Drug of choice – initial anticoagulant therapy in acute conditions
Heparin
Intravenous – IVP – IV infusion – Titrated Objective – APTT or PTT: should be 1 1/2 - 2 1/2 times the control SASH Antidote – Protamine Side Effects – Bleeding – Hypersensitivity
Low Molecular Weight Heparin
Enoxaparin (Lovenox) Dalteparin (Fragomin) Danaparoid (Orgaran) Adeparin (Normiflo)  Indication - Prevent DVT Onset action: 3 - 5 hrs Advantage - – Less expensive – Infrequent coagulation studies – Decrease bleeding
Antithrombotics
Action - Selective inhibitor of factor Xa – Prevent conversion of prothrombin
into thrombin
Indications
– DVT
– Risk for clots
Side Effects: bleeding, fever, rash, gastrotoxic, hepatotoxic, hypotension and hypokalemia.
Coumadin
Antidote: Vitamin K PO Prevents synthesis of vitamin K Inhibits clot formation Drug of choice - long term control Onset: 24 hr Optimal effect: 2 - 7 days Dose: 2- 15 mg/day – Based on PT and INR

Antiplatelets
Action - Inhibit platelet aggregation Indication - prevent CVA and MI
Glycoprotein IIb/IIIa Receptor Antagonist
Inhibit platelet aggregation Action: prevent binding of fibrinogen to GP IIb/IIIa receptors Indications – Unstable Angina – MI – During PTCA
Thrombolytics
Antidote- Amicar Dissolve fibrin clot Action: convert plasminogen into plasmin Indications – Acute, severe thromboembolic disease – clear IV obstruction Side effects – Allergy – Dysrhythmia – GI / GU bleeding
Hemostatics
Drug – Aminocaproic Acid (Amicar) ADR – N & V, stomach pain, cramping – Dizziness,HA, hallucinations, tinnitus, seizures – rust colored urine
Nursing Care
Heparin - APTT, PTT
Coumadin - PT, INR
Other tests – CBC, platelets and occult blood
Pt education - inform doctor/dentist
Vasodilators
Atherosclerosis - disease characterized by deposits of fatty plagues on the inner wall of arteries
Result - coronary artery disease, cerebral vascular disease and peripheral vascular disease
Action - Relax the smooth muscle layer of arterial blood vessels
Result - vasodilation
Two types Peripheral Coronary
Peripheral Vasodilators
Action Block alpha adrenergic receptors and stimulate beta adrenergic receptors Dilate vascular bed in the femoral blood vessels Inhibit platelet aggregation
Nitrates
Indication - Angina Pectoris
Action
Opens coronary blood vessels Decrease cardiac workload Decrease cardiac oxygen consumption
Sublingual Nitroglcerin
Sublingual - Acute attack, take at 5 min interval, if no relief call MD and go to hospital, don’t drive self. Can also use 5 to 10 min before strenuous activity.
Dose - 0.4 mg (gr 1/ 150) Pain disappear in 1 to 3 minute.
Throbbing headache indicates potency
Nitroglycerin
Lingual spray - 60 to 200 meter dose Indication - Acute Attack, Hypertension
Topical - Used for prophylactic as patch or ointment
Ointment measured in inches on dose measured paper
Onset 15 min, duration 5 to 8 hours
Cardiotonics
• Also called cardiac glycosides, inotropics
• Indications
– Heart failure
– Atrial fibrillation
– Atrial flutter
– Supraventricular tachycardia
• Increase cardiac output through positive inotropic activity
• Enhance movement of calcium into myocardial cells
• Decrease conduction velocity through the SA and AV nodes
• Result increase efficiency and improved contraction of the heart muscle
• Digitalization - A series of doses given until the drug begins to exert full therapeutic effect
Digoxin dose
• Loading dose: 0.5 to 1.25 mg every 6 to 8 hours initially
• Maintenance dose: 0.125 mg to 0.25 mg daily
• Serum digoxin levels 0.8 - 2 ng/ml.
– Blood drawn prior to dose or 6 - 8 hours after
Digoxin Toxicity
- GI–EARLYSIGN-N&V,anorexia,diarrhea
- CNS-headache,facialpain,apathy,drowsiness, disorientation, confusion, mental depression, delirium convulsion
- Visual-Blurred,halo,diplopia,coloredvision, yellow vision
- Cardiac - Bradycardia, tachycardia, extra systole/bigeminy/coupled beats, atrial fibrillation and atrial flutter
High Density Lipoproteins
HDL – Takes cholesterol from peripheral cells, dispose of in liver Normal: 35 to 60 mg/dl – Increase levels: decrease risk of CVD
Low Density Lipoprotein
LDL – Takes cholesterol from liver, dispose of in blood vessels Normal below 100 mg/dl High 160 to 189 mg/dl – Increase levels: increase risk of CVD
Antilipemics
Indication: high risk for atherosclerosis
Lower cholesterol Lower triglycerides
Bile Acid Sequestrants
Action - Forms a complex with bile
ADR
– GI toxicity
– Malabsorption of fat soluble vitamins
HMG-CoA Reductase Inhibitors or Statins
Action - Interfere with cholesterol synthesis
Side Effect
– Gastric irritation, flatulence, muscle pain and cramps, headache, lens opacity, cardiac arrhythmia
Fibric Acid
Lipid modifying agents
Action- affects synthesis & mobilization
of cholesterol
– Decrease triglycerides, increase HDLs and may decrease LDLs
Side Effects
– Skin rash, alopecia, allergy, flu like symptoms, angina, cardiac arrhythmia, cholelithiasis, pancreatitis
Cholesterol Absorption Inhibitors
Ezetimibe (Zeita)
Side Effects – Diarrhea
– Joint pains – Fatigue
Nicotinic Acid Derivatives
Lipid modifying agents
Action- affects synthesis & mobilization
of cholesterol
Side Effects -Severe flushing, tingling, itching rash
Drug
– Vitamin B 3
– Nicotinic Acid (Niacin)
