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Pharm > Cardiovascular System > Flashcards

Cardiovascular System Flashcards

1
Q

ACE inhibitors prototype and other drug names

A

captopril (Capoten), lisinopril, enalopril, ramipril

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2
Q

ACE inhibitors EPA

A

block enzyme that converts angiotensin I to angiotensin II thereby decreasing vasoconstriction and aldosterone (reducing retention of sodium and water), leading to vasodilation and retention of K+

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3
Q

ACE inhibitors adminitstration

A

PO

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4
Q

ACE inhibitors therapeutic use

A

treatment of HTN and heart failure

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5
Q

ACE inhibitors ADRs

A

orthostatic hypotension, dry non productive cough, hyperkalemia, angioedema, taste distortions, rash

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6
Q

ACE inhibitors contraindications and interactions

A

Pregnancy - teratogenic
Breastfeeding
Liver disease w/elevated liver enzymes
Avoid NSAIDs

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7
Q

ACE inhibitors RN intervention and client education

A

Avoid salt substitutes
Monitor BP before, during, and after
Educate patient regarding possibility of chronic, dry, unproductive cough
Monitor K+ due to potential for hyperkalemia
Potassium levels - 3.5-5

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8
Q

ARBs prototype and other drug name

A

losartan (Cozaar), valsartan (Diovan), and irbesartan (Avapro)

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9
Q

ARBs EPA

A

blocks vasoconstricting and aldosterone-secreting effects of angiotensin II. Increases renal blood flow. Vasodilation and retention of K+

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10
Q

ARBs administration

A

PO

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11
Q

ARBs therapeutic use

A

treatment of HTN; stroke prevention (losartan only); diabetic neuropathy (Losartan and Irbesartan); heart failure (vasartan)

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12
Q

ARBs ADRs

A

angioedema, dizziness, hypotension, headache, insomnia

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13
Q

ARBs contraindications and interactions

A

Pregnancy /breast feeding - teratogenic
Children <6
NSAIDs increase risk for renal complications

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14
Q

ARBs RN intervention and client education

A

Monitor BP before, during, after
Monitor K+ due to potential for hyperkalemia (much less risk than w/ACE)
Monitor for angioedema

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15
Q

aldosterone antagonists prototype and other drug names

A

eplerenone (Inspra)
Others: spironolactone (Aldactone)

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16
Q

aldosterone antagonists EPA

A

blocks aldosterone receptors thereby blocking effects of aldosterone - excretion of Na+, water and retention of K+

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17
Q

aldosterone antagonists administration

A

PO can take up to 4 weeks

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18
Q

aldosterone antagonists therapeutic uses

A

HTN and symptoms of heart failure following MI

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19
Q

aldosterone antagonists ADRs

A

hyperkalemia (very common)

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20
Q

aldosterone antagonists contraindications and interactions

A

Avoid medications that can raise potassium such as ACE inhibitors, potassium sparing diuretics
Do not take if serum K+ levels are >/=5.0 mEq/L
Avoid if breastfeeding
Use caution in children
NSAIDs may decrease effects
If client is also taking lithium, aldosterone MAY cause lithium toxicity

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21
Q

aldosterone antagonists RN intervention and client education

A

Monitor BP
Monitor for s/sx of hyperkalemia:
- Palpitations, muscle twitching, weakness, paresthesia in extremities, diarrhea
- Slow irregular heart rate
Periodic blood levels:
- Potassium (K+)
- BUN and serum creatinine
Avoid salt substitutes

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22
Q

direct renin inhibitors prototype

A

aliksiren (Tekturna)

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23
Q

direct renin inhibitors EPA

A

binds with renin thereby inhibiting activation of angiotensin I - vasodilation and urinary excretion of sodium and water

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24
Q

direct renin inhibitors administration

A

PO 1 hour before meals. Do not admin w/ fatty foods (decreases absorption). 2 weeks to reach therapeutic effect

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25
Q

direct renin inhibitors therapeutic use

A

HTN

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26
Q

direct renin inhibitors ADRs

A

diarrhea, dyspepsia, abdominal pain; low incidence of hyperkalemia, but still possible; angioedema; dry nonproductive cough similar to ACE but not as common

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27
Q

direct renin inhibitors contraindications and interactions

A

Pregnancy and lactation
Hyperkalemia (K+ > 5.0 mEq/L)
<18 year old
ACE inhibitors and ARBs
Increases blood levels of atorvastatin (Lipitor)

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28
Q

direct renin inhibitors RN interventions and client education

A

Monitor BP
Monitor for s/sx of hyperkalemia:
- Palpitations, muscle twitching, weakness, paresthesia in extremities, diarrhea
- Slow irregular heart rate
Periodic blood levels:
- Potassium (K+)
- BUN and serum creatinine
Avoid salt substitutes

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29
Q

Calcium channel blockers (CCB) prototype and other drug names

A

nifedipine (Adalat) or (Procardia)
Others: amlodipine (Norvasc), verapamil (Calan), diltiazem (Cardizem)

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30
Q

CCB EPA

A

block calcium channels in vascular smooth muscle cells of peripheral arteries - vasodilation and decreased BP

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31
Q

CCB administration

A

PO (IR or ER)

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32
Q

CCB therapeutic use

A

HTN; stable angina

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33
Q

CCB ADRs

A

reflex tachycardia, angina: vasodilatory effects: headache, dizziness, facial flushing, peripheral edema and arrhythmias. Gingival hyperplasia

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34
Q

CCB contraindications and interactions

A

Avoid in children
2nd and 3rd degree heart block
Many drug interactions (anti seizure meds)
Grapefruit juice increases blood levels

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35
Q

CCB RN interventions and client education

A

Monitor BP and heart rate. HOLD for SBP <90
Instruct client to periodically measure HR and BP
Risk for falls
Monitor for peripheral edema (diuretic)
Regular dental checkups
Avoid grapefruit juice and grapefruit

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36
Q

alpha 1 blockers prototype and other drug names

A

Prototype: doxazosin (Cardura)
Others: prazosin (Minipress)

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37
Q

alpha 1 blockers EPA

A

block alpha1 receptors - venous and arteriolar dilation

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38
Q

alpha 1 blockers administration

A

PO at bedtime

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39
Q

alpha 1 blockers therapeutic use

A

HTN and benign prostatic hypertrophy (BPH)

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40
Q

alpha 1 blockers ADRs

A

orthostatic hypotension; reflex tachycardia, headache, dizziness

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41
Q

alpha 1 blockers contraindications and interaction

A

Avoid in children
Liver disease
CONTRAINDICATED in sildenafil (Viagra)

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42
Q

alpha 1 blockers RN intervention and client education

A

Carefully monitor BP when changing positions
Risk for falls secondary to orthostatic changes
Raise slowly from sitting to standing

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43
Q

beta blockers prototype and other drug names

A

atenolol (Tenformin)
Others: metoprolol (Lopressor), carvedilol (Coreg)

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44
Q

beta blockers EPA

A

block beta1 receptors - dec in HR and contractility - cardiac output and suppresses reflex tachycardia. Block beta 1 in kidney - blocks renin release

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45
Q

beta blockers administration

A

PO (IR and ER) and IV

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46
Q

beta blockers therapeutic use

A

HTN, angina, dysrhythmias, MI, heart failure

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47
Q

beta blockers ADRs

A

bradycardia, heart failure, rebound excitation with sudden withdrawal

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48
Q

beta blockers contraindications and interactions

A

Bradycardia
1st degree heart block
Heart failure
Children <6
Asthma or COPD
May inc effects of oral hypoglycemia agents

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49
Q

beta blockers RN intervention and client education

A

Carefully monitor BP and HR
HOLD for SBP < 90 and HR < 60
Do not stop abruptly
Monitor for s/sx of heart failure: SOB, edema, coughing at night while orthopneic

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50
Q

direct acting vasodilators prototype

A

hydralizine

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51
Q

direct acting vasodilators EPA

A

acts directly on arterioles to relax smooth muscle leading to vasodilation. stimulates SNS, affecting heart rate

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52
Q

direct acting vasodilators administration

A

PO and IV

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53
Q

direct acting vasodilators therapeutic use

A

mod - severe HTN, hypertensive crisis

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54
Q

direct acting vasodilators ADRs

A

reflex tachycardia, dizziness, fluid retention

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55
Q

direct acting vasodilators RN intervention and client education

A

Monitor BP prior to, during, and after administration
Do not stop abruptly

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56
Q

cardiac glycoside prototype

A

digoxin (Lanoxin)

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57
Q

cardiac glycoside therapeutic use

A

management of mild to moderate heart failure in adults and children. The drug is also used to control the ventricular response rate in adults with chronic arterial fibrillation

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58
Q

cardiac glycoside administration

A

PO and IV

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59
Q

cardiac glycoside EPA

A

positive inotropic effect that improves the contractility and pumping ability of the heart. Increases the force of myocardial contractility by inhibiting NA, K, ATPase (increased calcium = increased contraction)

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60
Q

cardiac glycoside ADRs

A

digoxin toxicity. Very narrow therapeutic window! cardiac dysrhythmias

61
Q

cardiac glycoside RN intervention and client education

A

MANY med and herbal interactions
- Administer 1 hr prior to an antacid
Cardiac assessment - hold for a pulse <60 bpm
- Teach client how to check pulse
IV - SLOW IV push (at least 5 minutes)
Monitoring of serum drug levels
Educate client on s/sx of toxicity
Take at same time everyday and do not skip a dose - do not double dose

62
Q

cardiac glycoside contraindications and interactions

A

Clients w/ ventricular dysrhythmias, AV block, severe heart disease
Infants, children, and older adults = higher risk for toxicity

63
Q

Sympathomimetics prototype

A

dobutamine

64
Q

sympathomimetics therapeutic use

A

SEVERE heart failure - short term

65
Q

sympathomimetics administration

A

IV only!

66
Q

sympathomimetics EPA

A

beta-1 adrenergic agonist = increased inotropy = increased cardiac output

67
Q

sympathomimetics ADRs

A

tachycardia, dysrhythmias, possibly anginal pain

68
Q

sympathomimetics RN intervention and client education

A

Cardiac monitoring (telemetry, ECG)
Continuous vital signs
Monitor urine output

69
Q

sympathomimetics contraindications and indications

A

MAOIs and TCAs, general anesthesia

70
Q

phosphodiesterase inhibitor prototype

A

Milrinone

71
Q

phosphodiesterase inhibitor therapeutic use

A

short term management of acute to severe heart failure patients, in patients not responsive to digoxin, diuretics and vasodilators. Bridge therapy or longer term for palliation of symptoms

72
Q

phosphodiesterase inhibitor administration

A

IV only!

73
Q

phosphodiesterase inhibitor EPA

A

blocks PDE3 - enzyme that breaks down cyclic AMP = positive inotropic effect

74
Q

phosphodiesterase inhibitor ADRs

A

ventricular dysrhythmias. Hypotension, hypokalemia, anginal chest pain

75
Q

phosphodiesterase inhibitor RN intervention and client education

A

Continuous monitoring of BP, HR, and cardiac rhythm
Monitoring of electrolytes - K+
Monitor for chest pain

76
Q

phosphodiesterase inhibitor contraindications and interactions

A

Caution: aortic/pulmonary valve issues, acute MI
Also renal impairment, history of arrhythmias, electrolyte imbalances, abnormal digoxin levels

77
Q

loop diuretics prototype and other drug names

A

furosemide (lasix)
Others: bumetanide (Bumex) and torsemide (Demadex)

78
Q

loop diuretics administration

A

PO and IV

79
Q

loop diuretics therapeutic use

A

diuretic of choice when rapid effects are required (pulmoary edema), and when renal function is impaired - HF, HTN, pulmonary edema, renal and liver disease

80
Q

loop diuretics EPA

A

inhibits sodium and chloride reabsorption in the loop of Henle

81
Q

loop diuretics ADRs

A

hypokalemia, hyponatremia, hypochloremia, fluid volume deficit (dehydration), hypotension - orthostatic hypotension. Hyperglycemia and hyperuricemia. OTOTOXICITY!

82
Q

loop diuretics RN intervention and client education

A

Must administer IV dose slowly! 1-2 min per 20 mg
Monitor daily weights
Monitor I/Os
Monitor electrolytes - especially K+!!
- Hypokalemia = risk of dysrhythmias
Take BP before and after
Monitor renal function (CRE, BUN, GFR)
Educate client to report hearing loss, tinnitus, vertigo
Digoxin can increase risk of hypokalemia!

83
Q

loop diuretics contraindications and interactions

A

Caution w/electrolyte imbalances, dehydration
Caution w/ other ototoxic meds!
May increase lithium toxicity

84
Q

thiazide diuretics prototype and other drugs

A

hydrochlorothiazide (Microzide)
Other: chlorothiazide (Diuril)

85
Q

thiazide diuretics therapeutic use

A

mild to moderate HTN, edema d/t HF. Long term management of HF and HTN
Only works if the kidneys are making urine!

86
Q

thiazide diuretics administration

A

PO, chlorothiazide is IV

87
Q

thiazide diuretics EPA

A

inhibits reabsorption of sodium, water, chloride and bicarbonate in the distal convoluted tubal

88
Q

thiazide diuretics ADRs

A

electrolyte imbalances (hyponatermia, hypokalemia, hypochloremia), hyperglycemia, hyperuricemia

89
Q

thiazide diuretics RN intervention and client education

A

Give w/ food - ideally last dose before 1500
Monitor BP
Daily weights
Monitor I/O
Monitor electrolytes (K+) - watch for s/sx of imbalances
- Muscle twitching/weakness, irregular pulse, nausea
Monitor renal function (CRE, BUN, GFR)

90
Q

thiazide diuretics contraindications and interactions

A

Renal decompensation or anuria
With lithium, risk for lithium toxicity

91
Q

potassium sparing diuretics prototype

A

spironolactone (Aldactone)

92
Q

potassium sparing diuretics therapeutic use

A

HF, ascites (liver fx), HTN
In pt’s with HF and inadequate renal function the addition of spironolactone allows for smaller doses of loop diuretics and minimizes potassium loss

93
Q

potassium sparing diuretics administration

A

PO with food to increase absorption

94
Q

potassium sparing diuretics EPA

A

aldosterone antagonist - aldosterone has sodium retaining properties - decreased potassium excretion

95
Q

potassium sparing diuretics ADRs

A

common = dizziness, HA, abdominal cramping and diarrhea. Hyperkalemia. Can cause effects on the androgen receptors (deepening of voice, gynecomastia, menstrual irregularity, and testicular atrophy)

96
Q

potassium sparing diuretics RN intervention and client education

A

Monitor BP, I/Os, daily weights
Monitor for hyperkalemia
- Cardiac dysrhythmias
- Report: palpitations, irregular pulse
- Avoid K+ supplements/food. Salt substitutes
Lots of drug and herbal interactions
Educate client on endocrine effects

97
Q

potassium sparing diuretics contraindications and interactions

A

Teratogenic
Increased risk of hyperkalemia w/ ACE, ARB

98
Q

HGM-CoA Reductase Inhibitors *Antilipemic?Statins Prototype and other drug names

A

atorvastatin (Lipitor)
Other drugs: simvastatin (Zocor), lovastatin (Mevacor), and rosuvastatin (Crestor)

99
Q

statins EPA

A

Raise HDL and lower LDL and total cholesterol by inhibiting HMG CoA reductase, an enzyme that synthesizes cholesterol in the liver

100
Q

statins therapeutic use

A

used to treat high cholesterol and prevent vascular disease

101
Q

statins administration

A

PO, take in evening (the body makes cholesterol at night)

102
Q

statins ADRs

A

Myopathy (which can progress to rhabdomyolysis) and hepatotoxocity

103
Q

statins contraindications and interactions

A

Teratogenic
Current liver disease
ETOH use and disorder
Interacts with grapefruit juice and high risk of ADRs
Warfarin + statin + increased risk of bleeding

104
Q

statins RN intervention and client education

A

Report muscle pain to provider
Report abdomibnal pain, jaundice, and fatigue to provider
May need periodic liver function testing

105
Q

fibrates prototype and other drug names

A

gemfibrozil (Lopid)
Others: fenofibrate (TriCor)

106
Q

fibrates EPA

A

increases oxidation of fatty acids in liver and tissues, thus decreasing production of triglycerides

107
Q

fibrates therapeutic uses

A

most effective for reducing serum triglycerides, increasing HDLs too

108
Q

fibrates administration

A

PO

109
Q

fibrates ADRs

A

GI effects (N/D/abdominal pain), hepatotoxicity, gallstones, and myopathy

110
Q

fibrates contraindications and interactions

A

Avoid in someone with gall bladder disease
Liver disease
Severe renal impairment
Warfarin + fibrate = increased risk of bleeding
Risk of myopathy increases with concurrent use of statins

111
Q

fibrates RN intervention and client education

A

Recommended to take with food
Report muscle pain to provider
Report abdominal pain, jaundice, and fatigue to provider
May need periodic liver function testing

112
Q

nitrates *antianginals prototype

A

Nitroglycerin

113
Q

nitrates EPA

A

converts to nitric oxide, potent vasodilator; relaxes smooth muscle in blood vessel walls. Relieve angina pain by venous dilation, coronary artery dilation, and arteriole dilation

114
Q

nitrates therapeutic use

A

management/treatment of acute chest pain caused by myocardial ischemia

115
Q

nitrates administration

A

PO (SL, tablets, translingual spray), transdermal, topical ointment, IV

116
Q

nitrates ADRs

A

HA, hypotension, dizziness, bradycardia, syncope

117
Q

nitrates contraindications and interactions

A

Severe anemia
Hypotension
Hypovolemia
Use caution in renal impairment
AVOID phosphodiesterase enzyme inhibitors… sidenafil (Viagra) - Can produce LIFE THREATENING hypotension!!!

118
Q

nitrates RN interventions and client education

A

Educate client on how to take nitroglycerin at home for angina attack: Stop activity - lie or sit down, Put one SL tablet under tongue and let it dissolve, wait/rest 5 min. If pain unrelieved, place 2nd tablet under tongue
wait/rest another 5 minutes, if pain unrelieved, take 3rd tablet under tongue. If after 3 doses, pain is unresolved, seek medical attention immediately!!!
DO NOT take more than 3 tablets!!!
Spray substitutes for 1 SL tablet

In hospital or providers office-same protocol as above but would obtain an EKG first and then VS before each dose of nitro - Hold if systolic BP <90 and HR <60

Store SL nitro tablets out of sunlight and once open, use within ~4 months
Wear gloves when applying transdermal patches and topical ointment

119
Q

Class IB sodium channel blockers prototype

A

lidocaine

120
Q

Class IB sodium channel blockers EPA

A

blocks Na+ channels therebny shortening the repolarization phase of the cardiac cycle… decreases the rate of contractions of the heart

121
Q

class IB sodium channel blockers therapeutic use

A

treats serious ventricular dysrhythmias associated with MI, cardiac cath, and cardiac surgery

122
Q

class IB sodium channel blockers administration

A

only given IV in hospital setting

123
Q

class IB sodium channel blockers ADRs

A

hypotension, bradycardia, other dysrhythmias, and anxiety

124
Q

class IB sodium channel blockers contraindications and interactions

A

Untreated bradycardia or heart block
Pregnancy and lactation

125
Q

class IB sodium channel blockers RN intervention and client education

A

Continuous monitor of cardiac rhythm and vital signs
Avoid OTC cold med, asthma remedies and appetite suppressants that could aggravate irregular heartbeats

126
Q

class IC sodium channel blockers prototype

A

flecainide (Tambocor)

127
Q

class IC sodium channel blockers EPA

A

Blocks Na+ channel to slow conduction velocity and the refractory period

128
Q

class IC sodium channel blockers therapeutic use

A

treat atrial flutter or artrial fibrillation

129
Q

class IC sodium channel blockers administration

A

PO

130
Q

class IC sodium channel blockers ADRs

A

worsening heart failure, widens QRS complex, potential for other dysrhythmias to occur
BLACK BOX WARNING: can cause fatal arrhythmias and death in patients with recent MI

131
Q

class IC sodium channel blockers contraindications and interactions

A

Heart blocks
Heart failure

132
Q

class IC sodium channel blockers RN intervention and client education

A

Clients must be in hospital setting when therapy begins to monitor heart continuously
Cardiac monitoring and VS before each dose
Avoid OTC cold med… asthma remedies and appetite suppressants that could aggravate irregular heartbeats

133
Q

class II beta-adrenergic blockers prototype

A

propranolol (Inderal LA)

134
Q

class II beta-adrenergic blockers EPA and other info

A

Discussed during HTN/CAD lecture
Slows down the heart rate

135
Q

class III potassium channel blockers prototype

A

amiodarone

136
Q

class III potassium channel blockers EPA

A

blocks K+ channels in turn slowing repolarization and prolonging the refractory period to slow down the heart rate

137
Q

class III potassium channel blockers therapeutic use

A

treats various life-threatening ventricular and/or arterial tachy-dysrhythmias

138
Q

class III potassium channel blockers administration

A

PO and IV

139
Q

class III potassium channel blockers ADRs

A

fatal dysrhythmias and hypotension
BLACK BOX WARNING: long term use of amiodarone can cause fatal pulmonary toxicity

140
Q

class III potassium channel blockers contraindications and interactions

A

Heart block
Heart failure
teratogenic

141
Q

class III potassium channel blockers RN interventions and client education

A

Cardiac rhythm monitoring and VS before each dose
Take with food
Do not drink with grapefruit juice
IV route can be very harmful to small veins… need to watch!
Avoid OTC cold med, asthma remedies and appetite suppressants that could aggravate irregular heartbeats]increases the effects of beta-blockers, oral anticoagulants, digoxin and phenytoin

142
Q

class IV calcium channel blockers prototype and other drug names

A

diltiazem (Cardizem)
Others: verapamil (calan)

143
Q

class IV calcium channel blockers EPA

A

Blocks the Ca2+ channels, causing a slower conduction through the SA and AV nodes, slowing down the heart rate

144
Q

class IV calcium channel blockers therapeutic use

A

used to treat atrial tachycardias

145
Q

class IV calcium channel blockers adminsitration

A

PO or IV

146
Q

class IV calcium channel blockers ADRs

A

dizziness, bradycardia, and heart block

147
Q

class IV calcium channel blockers contraindications and interactions

A

Heart block
Heart failure

148
Q

class IV calcium channel blockers RN interventions and client education

A

Cardiac rhythm monitoring and vital signs before each dose
Avoid OTC cold med, asthma remedies and appetite suppressants that could aggravate irregular heartbeats

149
Q

Unclassified Antidysrhythmic Drugs

A

Adenosine
- Treats SVT
- Acts like a calcium channel blocker
- Only given in IV
- Vert short health life so must be given FAST through IV
Magnesium
- Treats torsades de pointe
- Mg2+ is the gatekeeper for Ca2+ being allowed into the cells. With low Mg2+ the gate is open and Ca2+ will flood the cell causing contraction and an irritable cardiac cell leading to dysrhythmias
- Given IV in acute setting and PO outpatient

Pharm (13 decks)

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