Cardiovascular PPTS

Question 1

Thrombosis

Answer 1

 Formation of a clot
 Any vessel
 Most common type - venous thrombosis (DVT)

Question 2

Anticoagulants

Answer 2

 Blood thinners
 Inhibit clot formation
 Prevent extension of clot
 Prevent additional clots from forming

Question 3

Heparin

Answer 3

 Inhibit clot formation
 Interferes fibrinogen conversion into
fibrin
 Drug of choice – initial anticoagulant therapy in acute conditions

Question 4

Heparin

Answer 4

 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

Question 5

Low Molecular Weight Heparin

Answer 5

 Enoxaparin (Lovenox)
 Dalteparin (Fragomin)
 Danaparoid (Orgaran)
 Adeparin (Normiflo)

 Indication - Prevent DVT
 Onset action: 3 - 5 hrs
 Advantage -
– Less expensive
– Infrequent coagulation studies – Decrease bleeding

Question 6

Antithrombotics

Answer 6

 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.

Question 7

Coumadin

Answer 7

 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



Question 8

Antiplatelets

Answer 8

 Action - Inhibit platelet aggregation  Indication - prevent CVA and MI

Question 9

Glycoprotein IIb/IIIa Receptor Antagonist

Answer 9

 Inhibit platelet aggregation
 Action: prevent binding of fibrinogen to
GP IIb/IIIa receptors
 Indications
– Unstable Angina – MI
– During PTCA

Question 10

Thrombolytics

Answer 10

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

Question 11

Hemostatics

Answer 11

 Drug
– Aminocaproic Acid (Amicar)
 ADR
– N & V, stomach pain, cramping
– Dizziness,HA, hallucinations, tinnitus, seizures
– rust colored urine

Question 12

Nursing Care

Answer 12

 Heparin - APTT, PTT
 Coumadin - PT, INR
 Other tests – CBC, platelets and occult blood
 Pt education - inform doctor/dentist

Question 13

Vasodilators

Answer 13

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

Question 14

Peripheral Vasodilators

Answer 14

Action
Block alpha adrenergic receptors and
stimulate beta adrenergic receptors
Dilate vascular bed in the femoral blood vessels
Inhibit platelet aggregation

Question 15

Nitrates

Answer 15

Indication - Angina Pectoris
Action
Opens coronary blood vessels Decrease cardiac workload Decrease cardiac oxygen consumption

Question 16

Sublingual Nitroglcerin

Answer 16

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

Question 17

Nitroglycerin

Answer 17

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

Question 18

Cardiotonics

Answer 18

• 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

Question 19

Digoxin dose

Answer 19

• 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

Question 20

Digoxin Toxicity

Answer 20

• 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

Question 21

High Density Lipoproteins

Answer 21

 HDL
– Takes cholesterol from peripheral cells,
dispose of in liver
 Normal: 35 to 60 mg/dl
– Increase levels: decrease risk of CVD

Question 22

Low Density Lipoprotein

Answer 22

 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

Question 23

Antilipemics

Answer 23

 Indication: high risk for atherosclerosis

 Lower cholesterol  Lower triglycerides

Question 24

Bile Acid Sequestrants

Answer 24

 Action - Forms a complex with bile
 ADR
– GI toxicity
– Malabsorption of fat soluble vitamins

Question 25

HMG-CoA Reductase Inhibitors or Statins

Answer 25

 Action - Interfere with cholesterol synthesis
 Side Effect
– Gastric irritation, flatulence, muscle pain and cramps, headache, lens opacity, cardiac arrhythmia

Question 26

Fibric Acid

Answer 26

 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

Question 27

Cholesterol Absorption Inhibitors

Answer 27

 Ezetimibe (Zeita)
 Side Effects – Diarrhea
– Joint pains – Fatigue

Question 28

Nicotinic Acid Derivatives

Answer 28

 Lipid modifying agents
 Action- affects synthesis & mobilization
of cholesterol
 Side Effects -Severe flushing, tingling, itching rash
 Drug
– Vitamin B 3
– Nicotinic Acid (Niacin)