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NURS 2514 > Coronary artery disease drugs > Flashcards

Coronary artery disease drugs Flashcards

1
Q

Goal for lipid lowering agents

A

Lower LDL: prevent plaque

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2
Q

Drug examples of lipid lowering agents

A

HMG-CoA reductase inhibitors (Atorvastatin)

Bile-Acid Sequestrates (Colesvelam)

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3
Q

Goal for nitrates: sublingual nitroglycerin

A

Control pain associated with ischemia

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4
Q

Drugs that prevent/ dissolve blood clots

A

Antiplatelet Therapy: ASA
Adenosine Diphosphate Receptor Antagonist: Clopidogrel (Plavix)

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5
Q

Drugs that reduce cardiac workload

A

Beta Adrenergic Blockers: Metoprolol
Ca Channel Blockers: Nifedipine
ACE Inhibitors: Captopril

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6
Q

Statins brand

A

Atorvastatin-Lipitor

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7
Q

Statins description

A

HMG-CoA reductase inhibitors
Drugs that lower lipoprotein production
Lowers LDL and total cholesterol
Increases HDL
Lower risk of heart failure, MI, and sudden death
Significant reduction in 2 weeks but effect goes away if drug is stopped

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8
Q

Statins MOA

A

Inhibits synthesis of cholesterol by blocking HMG CoA enzyme, increases LDL receptors in hepatocytes allowing for increased removal of LDL

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9
Q

Adverse effects of Atorvastatin (Lipitor)

A

Generally well tolerated
Headache, rash, memory loss, GI disturbance (usually transient)
Myopathy/ rhabdomyolysis (mild 5-10%)
Hepatotoxicity (0.5-2%)

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10
Q

Nursing considerations of Atorvastatin (Lipitor)

A

Dose should be given in the evening because of cholesterol synthesis
GI assessment
Monitor Liver and Renal Function
Observe for muscle pain (often legs)

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11
Q

Colesevelam (Welchol) effect

A

Decrease in LDL ~20% after one month

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12
Q

Colesevelam (Welchol) MOA

A

A non-absorbable resin that binds bile acid preventing reabsorption

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13
Q

Bile is made from _____

A

cholesterol

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14
Q

Colesevelam can be _________

A

Colesevelam can be used together with statins

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15
Q

Metoprolol (Lopressor) MOA

A

Blocks cardiac Beta 1 adrenergic receptors
Reduces heart rate, force of contraction, decreased renin secretion

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16
Q

Indications for metoprolol

A

Lowers blood pressure in the large veins by slowing heart rate and widening vessels

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17
Q

Adverse effects of metoprolol

A

Bradycardia, AV heart block, heart failure, arrhythmias

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18
Q

Nursing considerations for metoprolol

A

Assess HR prior to admin
Monitor HR, chest pain, BP, and palpitations
Monitor for early signs of heart failure
Withdraw medication slowly, do not abruptly discontinue

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19
Q

Early warning signs of heart failure

A

Shortness of breath after mild exertion or lying flat, edema, weight gain, coughing at night

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20
Q

Precautions of beta-adrenergic antagonists and epinephrine

A

Epinephrine activates beta 1 receptors in heart, and beta 2 receptors in lungs, if the receptors are blocked, epinephrine may not work

21
Q

Precautions of beta-adrenergic antagonists and diabetes

A

Blocks beta 1 receptors which give early warning signs of hypoglycemia (tachycardia, tremors, perspiration)

22
Q

Calcium channel blockers drug example

A

Verapamil (Isoptin)

23
Q

Verapamil (Isoptin) MOA

A

Inhibits ca ion influx across cell membrane. Heart: lowers SA/AV conduction, lowers HR, lowers force of contraction.
Arteries/ arterioles: Block ca channels on vascular smooth muscle causing vasodilation (coronary and peripheral arteries/ arterioles)

24
Q

Indications for verapamil (Isoptin)

A

Angina, hypertension, and cardiac dysrhythmias

25
Q

Therapeutic effect of verapamil (Isoptin)

A

Vasodilation, slows ventricular rate (good for atrial arrhythmia)

26
Q

Adverse effects of verapamil (Isoptin)

A

Constipation, dizziness, facial flushing, headache, edema to legs and feet

27
Q

Captopril MOA

A

Block production of angiotensin II and prevent breakdown of bradykinin which results in vasodilation, lowered blood volume, lowered cardiac remodelling, can lead to K retention

28
Q

Therapeutic effects of ACE inhibitors

A

Vasodilation, lowered blood volume, lowered cardiac remodeling

29
Q

Adverse effects of ACE inhibitors

A

Hypotension, cough, hyperkalemia, renal failure, angioedema

30
Q

Nursing considerations for ACE inhibitors

A

Assess BP, pulse
Assess for signs of heart failure
Monitor hydration status
Monitor blood work (K, Urea, Creatine)

31
Q

Precautions for ACE inhibitors

A

Caution with impaired renal function, hypovolemia, drugs that increase K (K-sparing diuretics)

32
Q

Nitroglycerin spray (organic nitrate) MOA

A

Dilates veins in body to decrease venous return and preload which decrease workload (stable angina)
Dilates coronary arteries and increases collateral blood flow to ischemia regions
Relaxes vasospasm in coronary arteries (vasospastic angina)

33
Q

Adverse effects of nitroglycerin spray (organic nitrate)

A

Headache, hypotension, tachycardia (secondary to vasodilation)

34
Q

Difference between nitroglycerin spray (organic nitrate) and isosorbide dinitrate (long-acting nitrate)

A

isosorbide dinitrate (long-acting nitrate) can be in pill form to last all day. Available in immediate release and sustained release options

35
Q

ASA MOA

A

Suppresses platelet aggregation by causing irreversible inhibition of cyclooxygenase (an enzyme)
Reduces risk of arterial thrombosis

36
Q

Adverse effects of ASA

A

Risk of GI bleed (2.7%) - PPI used if bleeding occurs, abdominal pain, dyspepsia, diarrhea, rash

37
Q

Indications for ASA

A

Chronic stable angina, unstable angina, acute MI, primary and secondary prevention of MI

38
Q

Clopidogrel (Plavix) MOA

A

Irreversibly blocks P2Y12ADP receptors on platelets, preventing platelet aggregation through this pathway

39
Q

Clopidogrel (Plavix) indications

A

Prevention of stenosis of coronary stents. Secondary prevention of MI

40
Q

Dalteparin (Fragmin) MOA

A

Enhance activity of antithrombin
As effective as UFH but can be given in fixed dose
More expensive than UFH
Can be used by out-patients (no bloodwork required)

41
Q

Indications for dalteparin

A

USA, NSTEMI, DVT and PE prevention

42
Q

Adverse effects of dalteparin (Fragmin)

A

Bleeding (4%), bruises, black stool, hematuria, headaches, lumbar pain, HIT

43
Q

Unfractionated heparin MOA

A

Enhance activity of antithrombin
Cheaper to use than LMWH
Require more monitoring (including regular aPPT)
Only used in hospital setting

44
Q

Indication for UFH

A

Acute MI, DVT, PE

45
Q

Adverse effects of UFH

A

Bleeding (10%), bruises, black stool, hematuria, headaches, lumbar pain, HIT

46
Q

Alteplase (tPA) MOA

A

Binds to plasminogen -> plasmin (enzyme that digest fibrin)
Most effective when given within 4-6 hours of symptom onset (max 24hrs)

47
Q

Indication for alteplase (tPA)

48
Q

Absolute contraindications for alteplase (tPA)

A

Prior intracranial hemorrhage
Recent stroke (last 3 months)
Active internal bleeding

NURS 2514 (14 decks)

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